Effectiveness of Sacroiliac (SI) Joint Steroid Injection

Steroid injection of SI joints can be very helpful. It is more common than one would think as is seen in post-traumatic cases, in celiac disease, in various colitis, and in certain Fibromyalgia misdiagnosed subgroups. I highlight this study so patients can see its benefits.

Şahİn, Orçun, et al.
An intraarticular sacroiliac steroid injection under the guidance of computed tomography for relieving sacroiliac joint pain: A clinical outcome study with two years of followup. Archives of Rheumatology 27.3 (2012): 165-173.
http://www.tjr.org.tr/full-text-pdf/468

as mentioned above,

SI joint inflammation is seen in celiac:
Usai, Paolo, et al.
Adult celiac disease is frequently associated with sacroiliitis.
Digestive diseases and sciences 40.9 (1995): 1906-1908.
http://link.springer.com/article/10.1007/BF02208654#page-1
“Bone scintigraphy was positive for sacroiliitis in 14 cases (63.6%). Except in the case of one patient suffering from rheumatoid arthritis, laboratory data were normal.”

Colitis -often has sacroiliac involvement – for example:
Got Crohn’s? – May Have Spine Arthritis Too
http://painmuse.org/?p=146
“Recent MRI study of crohn’s colitis patients found 17/44 cases had evidence to sacroiliitis”

Criteria:

  1. Laterally located pain over SI Joint line
  2. Positive findings on at least one of the following three provocation tests
    for  SIJ pain:
  •  Gaenslen’s test in which the hip joint is flexed maximally on one side, and the opposite hip joint is extended, stressing both sacroiliac joints simultaneously)
  • Patrick’s test [flexion, abduction external rotation (FABERE) test]
  • thigh thrust (my favorite)

 

  • a negative response to Kemp’s test,”^’ one of the pain provocation tests for sciatica (Patient’s trunk rotates obliquely downward in the affected lumbosacral area. A positive response is obtained if the lower back pain radiates into the lower extremities).

3. No disorders in the hip joint

4. No signs of lumbar radiculopathy

5. No findings suspicious of infectious arthritis on the laboratory investigation or on plain radiograph

Injection technique refers to an older article :

Bollow M, Braun J, Taupitz M, Haberle J, Reibhauer BH, Paris S, et al.
CT-guided intraarticular corticosteroid injection into the sacroiliac joints in patients with
spondyloarthropathy: indication and follow-up with contrast-enhanced MRI.
J Comput Assist Tomogr  1996:20:512-21

both say they used xray guidance:

I printed a proposal for SI injection:

Sacroiliac Joint Injection Proposal
http://painmuse.org/?p=4249

They contend that blind injections have poor success:

Due to the complex anatomy, SIJ injections have a very low success rate of 12-20% when performed using only clinical judgement.’^”’*-“‘ In addition, radiological imaging as a guidance method has been recently applied to place the needle into the SIJ space.

They do not conclude however that that increases success rate of injection:
“An increasing success rate with regard to the correct positioning of the needle starting from 60% at the first 30 injections and improving to 93.5% with the last 30 injections has been demonstrated, but the therapeutic efficacy or clinical outcome of this intervention has not been evaluated.‘”*”

Second article mentioned stated 92.5% “showed a significant abatement of subjective complaints after a mean of 1.7 ± 1.1 weeks after corticosteroid injection, and this improvement lasted for 10 ± 5 months. ” They used 40 mg each SI joint = 80 mg

first article as printed initially:

I would contend that:

  • Blind injection is just as satisfactory as long as 80 mg is used (in one Joint or 40 in each
  • People seem to ignore that the sacroliiac ligaments are often inflamed as well and 10 mg triamcinolone into them is sometimes necessary.

Comment – a very successful form of treatment but often the pain regionalizes and muscles – gluteal and piriformis can be involved and need treatment as well.

 

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