Sacroiliac Joint Injection

KEY FACTS

Terminology

• Image-guided injection of corticosteroid and long-acting anesthetic into sacroiliac (SI) joint

Preprocedure

• Indications

  • Diagnostic injection for hip/back/buttock pain

  • Sacroiliitis

  • Synovial cyst associated with SI joint

Procedure

• Prone

  • Oblique tube angulation to “open” SI joint

• Advance needle under intermittent imaging until “pop” into joint space is felt or bone is reached

• Inject small amount of contrast under fluoroscopy to confirm intraarticular needle placement

  • Should see contrast track cephalad along SI joint

  • Should not see pooling or “feathering” of contrast at needle tip

• Take note of pain before, during, and after injection

  • Whether or not concordant pain was elicited during procedure

Outcomes

• Expected

  • Improved pain score following injection

• Problems

  • Pain not relieved

  • Vasovagal reaction

  • Clinical failure: SI joint not pain generator

  • Technical failure: Extraarticular injection

• Most feared complications

  • Infection

  • Osteomyelitis

  • Septic joint

TERMINOLOGY