1. What is the Sacroiliac Joint?
At the lower end of the spine lies the Sacrum. The Sacrum is a triangular shaped bone formed by the fusion of several smaller bones. The Sacroiliac (SI) joint sits between the Sacrum and the Ilium. The Sacroiliac joint has an irregular surface and has very little motion. The older one gets, the less motion occurs in the joint.
2. How do I know if the Sacroiliac Joint is the cause of my pain?
Sacroiliac joint problems are one of many causes of low back pain. Sacroiliac joint dysfunction may be difficult to diagnose. X-rays, CAT scans and MRIs may be normal and several other problems can mimic the pain of SI joint dysfunction. One maneuver called the FABER test can provoke pain caused by SI joint problems. With this maneuver, the patient is lying down and the physician flexes, abducts and externally rotates the hip. If this maneuver reproduces the pain, then the Sacroiliac joint may be the problem. If the diagnosis is still unclear, an injection into the joint may give the answer.
3. How is Sacroiliac Joint pain treated?
Initially, conservative treatment is prescribed. This consists of rest, anti-inflammatory medications and physical therapy. If this is not successful, an injection into the joint may help. A pain specialist does this, usually an anesthesiologist, using X-Ray guidance.
4. How is the injection done?
First, you will have a consultation with the pain specialist. Once he determines that you are a candidate for the injection, he will schedule your procedure. If you are taking any medications, such as blood pressure medications or blood thinners, you will need to discuss this with the doctor to determine whether or not to continue with them prior to the procedure. If you are diabetic, the doctor will need to know that as this injection may cause a rise in blood sugar several days after the procedure. You must have someone with you after the procedure to drive you home. The injection is usually quick, only several minutes for each side. The skin is numbed with a small amount of local anesthetic (lidocaine). Once the numbing medication is given, there is little or no pain during the injection. Although sedation is usually not necessary, a small amount of sedation can be given for an anxious patient. The needle is placed in the joint under X-ray and the medication is then given. You will have a brief recovery and will then be discharged home with your driver.
5. What should I expect after the procedure?
Immediately after the procedure, you may feel that your pain is less. This is due to the local anesthetic. After the local anesthetic has worn off in several hours, the pain will return. You may have some slight soreness at the injection site for several days due to the irritation from the needle. The medication itself may take several days to work. The duration of pain relief is different for each patient. For some patients, the pain relief may last from several days to as long as several months.
6. How many injections do I need?
You may get significant pain relief from the first injection and a second injection may not be necessary. If the first injection does not completely relieve your pain, a second may then be given. Usually no more than three injections are given within 6 months. If the injections do not relieve your pain, then the source of the discomfort may not be the sacroiliac joint. There are several problems that cause similar symptoms including bulging or herniated discs, spinal stenosis and disease in the facet joints of the spine.
7. What are the risks of the injection?
Generally speaking, this is a simple and safe procedure. The most common side effect is pain at the site where the needle was inserted. This should resolve within several days. Bleeding and infection are a risk of any injection at any site. There are some side effects that can occur from the medication that is injected. This includes a rise in blood sugar, weight gain and water retention. These effects are minimized by using low doses of the medication and limiting the number of injections to three within 6 months.
8. Should I get the injection?
That decision can only be made after you see the pain specialist. He will discuss all of your options for treatment including injections. After the evaluation, he will determine if a problem in the sacroiliac joint is the likely source of your problem and if you are a candidate for the procedure.