Sacroiliac Joint Injections
The sacroiliac joint is the longest joint in the body and connects the spine to the pelvis. It bears a very large weight load and is held together only by ligaments that can be damaged in automobile accidents, birthing, or lifting injuries. Damage to the ligaments can cause the joint to become hyper-mobile and painfully unstable, requiring re-alignment by chiropractors or physical therapists, or by the patient.
The joint surfaces can become arthritic and painful due to osteoarthritis, rheumatoid arthritis, and several other types of arthritis. Usually, the pain from dysfunction of this joint is one-sided in the low back and buttocks and may refer to the back of the thigh and occasionally into the calf.
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Sacroiliac Joint Injections
The sacroiliac joint is the longest joint in the body and connects the spine to the pelvis. It bears a very large weight load and is held together only by ligaments that can be damaged in automobile accidents, birthing, or lifting injuries. Damage to the ligaments can cause the joint to become hyper-mobile and painfully unstable, requiring re-alignment by chiropractors or physical therapists, or by the patient.
The joint surfaces can become arthritic and painful due to osteoarthritis, rheumatoid arthritis, and several other types of arthritis. Usually, the pain from dysfunction of this joint is one-sided in the low back and buttocks and may refer to the back of the thigh and occasionally into the calf.
UNDER NO CIRCUMSTANCES SHOULD A PAIN DOCTOR OR ANESTHESIOLOGIST EVER GIVE THESE INJECTIONS WITHOUT X-RAY GUIDANCE SINCE THIS IS NOT ONLY DANGEROUS BUT AT LEAST 50-60% OF THE TIME THE INJECTIONS ARE GIVEN IN THE WRONG PLACE.
What is a Sacroiliac Joint Injection (si)?
Sacroiliac injections involve the use of an x-ray-guided needle placed into the bottom of the join or into the ligaments over the joint. It is impossible to accurately place an injection into the SI joint without x-ray guidance. Usually, the needles are placed deep into the joint, and iodine contrast or dyes are used in the joint to assure proper placement. After the needle is in place in the SI joint, an injection of local anesthetic is administered, and you will assess your pain over the next several hours as part of this diagnostic test. Sometimes steroids are added to the local anesthetic injected.
Do the injections hurt?
Usually, the injection is not very painful and is very brief. Rarely patients may receive IV sedation with this procedure.
Risks
Bleeding, infection, nerve injury spinal cord injury, and abscess are all rare
Medicines to withhold:
- Stop Aspirin and Plavix 7 days before the procedure.
- Stop coumadin, and warfarin 4 days before the procedure.
- Stop Ticlid 14 days before the procedure.
- Take all your other medications on the day of the procedure.
Discharge instructions
- Activity: Resume normal activity today, especially if the block is for diagnosis.
- Diet: Resume normal diet
- Medications: Resume normal medications unless otherwise instructed.
- Dressing: You may have a small band-aid or band-aids placed over the injection site. This can be removed the next day
- Discomfort at the Injection Site: Apply ice wrapped in a washcloth for short periods of time (20 minutes per hour) during the first 24 hours, and then apply low to medium heat
- IV Site: If you had an IV, there may be soreness and bruising around the IV site that will go away in a few days. A warm moist cloth placed over the area for half-hour periods several times a day will sometimes help. Increased tenderness or red streaking around the area of the IV site or increasing swelling of the hand requires attention. Our clinic needs to be notified if this occurs Side Effects: Possible side effects of local anesthetics used include numbness of the leg or arms. Let us know if this occurs. Steroid side effects include an elevation of your blood sugar for a week especially if you are diabetic. More frequent checks of the blood sugar are necessary for the first week after injection if you are a diabetic. Also, steroids may cause increased blood pressure for a week and if you have hypertension or are being treated with medications for hypertension, you need to check your blood pressure more often during the first week. The medication doses for diabetes and high blood pressure may have to be adjusted during the first week or so after a steroid-containing injection.
Some patients experience facial flushing or having excessive energy during the first 24 hours after the injection. If you experience new onset severe generalized weakness during the first week after the injection, call our office. If you develop fever of more than 102 degrees during the first few days after the injection or severe increase in pain in the back, notify our office.
EMERGENCY CONTACT TELEPHONE NUMBER: 911
Return to normal
You may experience some numbness in the skin over the back during the first several hours. Relief from the diagnostic injection may last up to 12 hours. Steroids, if used, may require hours to have an effect.
Anesthetic effects
Refrain from operating motor vehicles within the first 12 hours after the injection.
PERFORMANCE OF THIS TECHNIQUE WITHOUT FLUOROSCOPY OR CT MAY CONSTITUTE FRAUD SINCE IT IS VIRTUALLY IMPOSSIBLE TO ENTER THE JOINT WITHOUT RADIOGRAPHIC GUIDANCE
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