The Basics of Sacroiliac (SI) Joint Injections

A sacroiliac (SI) joint injection involves administering medication directly into one or both joints of the lower back region. The procedure is done as an outpatient technique, and most patients go back to work the next day.

What medications are used in the SI joint injection procedure?

The sacroiliac joint injection involves injecting the joint with a local anesthetic and a corticosteroid medication. Due to the nature of the numbing agent, you may have immediate pain relief. If a corticosteroid is used, it begins to work after 3-4 days, decreases inflammation, and provides long-lasting pain relief.

Who is a candidate for SI joint injections?

The procedure cannot be performed if you have poorly controlled blood pressure, are on blood thinners for a serious heart problem, or have an active infection. The procedure is used for people who have SI joint pain due to arthritis, and those who have not responded to other treatment modalities.

Do the injections into the sacroiliac joints hurt?

You may feel a slight burning sensation when the numbing agent is used to numb your skin, or when the medications are being injected. After the injection, expect some tenderness of the injection sites. However, this resolves in a few hours.

What do I do to prepare for the SI injection procedure?

You can have no solid food or fluids after midnight before your procedure. However, you can take necessary medications with a small sip of water. If you are on blood thinning agents, you must hold these for a few days beforehand. The pain management specialist may order some additional tests before the procedure. Be sure you wear loose-fitting clothing to your appointment, leave all valuables at home, and arrange to have someone take you to your residence. When you arrive at the medical center, a nurse reviews the procedure and has you sign a consent form.

What happens during the SI injection procedure?

A nurse will place an IV line in your arm after you change into a gown. Once you are positioned face-down on the table, the nurse administers a sedative, and cleans your lower back with an antimicrobial solution. The doctor numbs the skin and deeper tissues with an anesthetic, and the doctor inserts the procedure needle into the joint using a special x-ray (fluoroscopy). The other side is injected if necessary. After the needle is withdrawn, a small bandage is applied.

What can I expect after the SI joint injection?

After the SI joint injection, you will feel some soreness of the very low back region. The pain starts to wear off, and the steroidal agent takes effect in 2-3 days. Use ice packs to alleviate soreness, and avoid driving for 24 hours. You should avoid showering, soaking in water, or getting in a sauna for 24 hours, and rest for a few days. A nurse monitors your condition as you become alert after sedation. Once you are up and moving, you are discharged home.

Do sacroiliac joints work?

In a double-blind randomized study involving patients with sacroiliitis, patients were injected with a placebo or steroidal agent. At one month after the procedure, 80% of patients reported pain relief in the corticosteroid group. No patients had pain relief in the placebo group.

Resources

Hansen H, Manchikanti L, Simopoulos TT, Christo PJ, Gupta S, Smith HS, et al. A systematic evaluation of the therapeutic effectiveness of sacroiliac joint interventions. Pain Physician. 2012 May-Jun. 15(3):E247-78.

Hawkins J, Schofferman J. Serial therapeutic sacroiliac joint injections: a practice audit. Pain Med. 2009 Jul-Aug. 10(5):850-3.

Liliang PC, Lu K, Weng HC, Liang CL, Tsai YD, Chen HJ. The therapeutic efficacy of sacroiliac joint blocks with triamcinolone acetonide in the treatment of sacroiliac joint dysfunction without spondyloarthropathy. Spine (Phila Pa 1976). 2009 Apr 20. 34(9):896-900.

Maugars Y, Mathis C, Berthelot JM, et al. Assessment of the efficacy of sacroiliac corticosteroid injections in spondylarthropathies: a double-blind study. Br J Rheumatol. 1996 Aug. 35(8):767-70.