What are the indications for sacroiliac joint injections?

A sacroiliac joint injection is generally indicated for buttock pain, which may radiate to the thigh or lower leg. When diagnosing sacroiliac joint pain, there are several physical exam maneuvers that your clinician may have you perform. One of these maneuvers is the Patrick test or Faber maneuver. During this maneuver, you will lie on your back, and the heel of the painful side will be placed on the opposite knee. The clinician will then apply pressure on the flexed knee and the opposite buttock area. This test is considered positive for sacroiliac joint dysfunction if pain is elicited in the affected buttock.

How do sacroiliac joint injections help my pain?

 Once the diagnosis of sacroiliac joint pain is made, you can schedule a sacroiliac joint injection. During this injection, medication is placed into the sacroiliac joint to help alleviate the buttock pain, which comes from this inflamed joint.   The medication injected is generally a combination of steroids and anesthetics.

How do I prepare for this procedure?

A sacroiliac joint injection is a minor surgical procedure that is typically performed in an ambulatory surgery center. You should not eat or drink anything for at least 2 hours before your procedure. You should continue to take all of your routine medicines except blood thinners the day of your procedure.

Sacroiliac Joint Injection

What should I expect during the procedure?

You will be lying face down on an X-ray table during the procedure. You may have pillows placed under your abdomen to help your physician with optimal positioning. Live X- rays, known as fluoroscopy, will then be taken to ensure proper positioning.

Your buttock area, over the sacroiliac joint, will then be cleaned with an antiseptic solution and a sterile drape will be placed over this area to keep it clean for the procedure. A local anesthetic will then be injected into your skin to make it numb. The needle will then be inserted through the numbed skin and slowly advanced into the sacroiliac joint space using fluoroscopy to guide the needle. When the needle enters the sacroiliac joint space, it is common to feel increased pressure in the buttock area.

Once the needle is in the sacroiliac joint space, a small amount of contrast will be injected under live X-ray to ensure that the medication will spread properly. After this, the corticosteroid will be slowly injected into the sacroiliac joint space. It is very common to feel increased pressure during this part of the procedure. Once the injection is complete, the needle will be withdrawn and a dressing will be placed over the injection site.

Can I have sedation for the procedure?

The vast majority of patients do not require sedation for the procedure; however, we can provide light sedation for the procedure at your request. Patients who are receiving sedation must have a responsible adult with them to drive them home.

How soon can I go home after the procedure?

Your blood pressure, pulse, and breathing will be checked frequently over the next 15 to 20 minutes. Once your vital signs are stable, you will be able to go home.

Can I drive myself or do I need a ride?

Most patients prefer to have a family member or friend drive them for their procedure; however, you may drive yourself to the procedure as long as you are not requesting sedation. Patients who are receiving sedation must have a responsible adult with them to drive them home.

How long will it take for the pain relief to take effect?

Some patients will experience immediate relief, however, it usually takes 24 to 72 hours for the effects of the steroid medication to take effect and it may be up to 1 week before the maximum benefits are achieved.

Can the procedure make my pain worse?

Some patients will experience mild pain with the procedure that will ease up in a very short amount of time. On rare occasions, patients have experienced a prolonged increase in pain after the procedure.

What if the procedure does not improve my pain?

Sacroiliac joint injections target the pain being caused by the inflamed nerves in your buttock area and may not relieve pain caused by muscular problems, which can continue to cause pain after the procedure. You may continue to require oral medications or other interventional procedures to achieve better pain relief.

How many injections do I need? How often can I have an injection?

In general, if the injections are successful, most patients will experience at least 6 months of pain relief after the initial series of injections. You may return for future injections when the pain returns.

Are there any restrictions following the procedure?

We ask that you not immerse in water for 24 hours after the injection. This means that you can shower, but not take a bath or go swimming for the rest of the day. There are no other specific restrictions on activity; however, we recommend that you “take it easy” the rest of the day and slowly resume your normal activities.

What are the risks of the procedure?

Overall, sacroiliac joint injections are a very safe procedure. Serious side effects or complications are rare with sacroiliac joint injections. However, like all injection procedures, possible adverse effects are possible. The most common complication is bleeding and bruising at the needle puncture site. Other very rare complications include infection, hematoma (bleeding into the joint space), contrast or allergic reactions, and death. If you experience any concerning symptoms after your injection, you should call your doctor immediately or go to an emergency room for evaluation.