Pain Management Procedures
Sacroiliac Joint Injection
Sacroiliac Joint Injection
What is it?
The sacroiliac, or SI, joints connect the sacrum at the base of the spine to the pelvis. Pain from an SI joint is usually felt below the belt line in the low back or buttock and can spread toward the groin or upper leg. An SI joint injection places medication inside the joint for diagnostic testing or treatment.
When may it be recommended?
SI-joint pain is considered when the history and several physical examination maneuvers reproduce the usual symptoms and other likely causes have been assessed. A diagnostic injection uses local anesthetic to test the joint. A therapeutic injection commonly adds corticosteroid to reduce inflammation.
What happens?
You lie face down. Fluoroscopy guides a thin needle into the joint. Contrast dye confirms that the needle is in the correct space before anesthetic and, when planned, steroid are injected. You may be asked to record pain before and after the procedure and repeat movements that normally hurt.
What should I expect?
The buttock or leg may be temporarily numb or weak. Diagnostic relief is expected to be short and should match the anesthetic's duration. Steroid benefit may take several days and can last weeks or months. A response can guide consideration of therapy, lateral-branch RFA, or, in carefully selected cases, fusion.
Important risks and limitations
Risks include bleeding, infection, medication reaction, temporary weakness, increased pain, and elevated blood sugar. No single examination finding or scan proves SI-joint pain. Coverage criteria for repeat injections, RFA, and fusion vary and may require documented improvement after diagnostic procedures.
Preparing for your injection procedure…
Your instructions will depend on the procedure. Before any injection, tell the APG team if you:
Take aspirin, warfarin, clopidogrel, apixaban, rivaroxaban, or another medicine or supplement that affects bleeding. Never stop a prescribed blood thinner unless the clinician who manages it and the procedure team tell you how to do so safely.
Have diabetes, glaucoma, a bleeding disorder, an active infection, fever, or recent antibiotic treatment.
Could be pregnant, have an allergy to contrast dye or local anesthetic, or have reacted to steroid injections before.
Use an implanted pacemaker, defibrillator, spinal cord stimulator, or other electrical device.
Some procedures require fasting, a medication adjustment, or a responsible adult to drive you home, especially when sedation is planned. Follow the instructions provided for your specific appointment.
After your injection procedure…
Most injections are outpatient procedures. Mild soreness, bruising, temporary numbness, or a brief increase in the usual pain can occur. Follow the activity and bandage instructions you receive. Steroid medicine may take several days to have an effect and can temporarily raise blood sugar.
Call the office promptly for increasing redness, drainage, fever, severe or rapidly worsening pain, or new numbness or weakness. Seek emergency care for trouble breathing, chest pain, sudden loss of bladder or bowel control, a severe new headache, loss of vision, stroke-like symptoms, or rapidly progressing weakness.
This information is for general education and does not replace medical advice, diagnosis, or treatment. Not every procedure is appropriate for every patient, and results vary. Your APG care team will review your symptoms, examination, imaging, medical history, medications, and prior treatment before recommending a plan. Coverage requirements also vary by insurance plan.