Sacroiliac joint pain is an under-recognised cause of buttock or groin pain. Generally, treatment consists of exercise therapy and modification of activity. However, not all cases can be resolved with simple treatments so that an SI joint injection may be necessary in some instances. When and how is a sacroiliac joint injection performed?
What is the sacroiliac joint?
The sacroiliac joints are between the sacrum (below the lumbar spine) and the pelvic bones. Essentially, they provide shock absorption and transfer load from the lower body to the upper body.
Causes of sacroiliac joint pain
Usually, repetitive trauma or force on the sacroiliac joint can come from activities such as running. However, other triggering factors include a direct fall onto the sacroiliac joint, an autoimmune disorder that attacks the sacroiliac joint (sacroiliitis), or pregnancy.
Diagnosis of sacroiliac joint pain
In general, diagnosing sacroiliac joint pain can be a challenging task. Firstly, symptoms overlap with other causes, such as a herniated disc in the spine or hip arthritis. Moreover, special tests for sacroiliac joint pain are not a slam-dunk for this condition. Finally, imaging is often normal despite actual SI joint pain being present.
MRI helps exclude a condition known as sacroiliitis, an inflammatory condition affecting the sacroiliac joints. Sometimes, an MRI can rule out pain from the lumbar spine (Sciatica) or pelvis (hamstring origin tendinopathy).
A few experts believe that an image-guided sacroiliac joint injection is the most effective test for SI joint pain. For example, if a person experiences a 75% decrease in pain after an injection, we can be more sure that the pain is from the joint.
Treatment, including sacroiliac joint injection
Generally, we recommend simple treatments first. Physiotherapy involves exercises that strengthen muscles, improve mobility, and address soft tissue issues. Moreover, a brace to support the joint can be helpful, particularly during pregnancy. Anti-inflammatory tablets, such as ibuprofen, can also help alleviate pain.
If sacroiliac joint pain persists, we consider a sacroiliac joint injection as a treatment option.
Rarely do we ever consider surgery, if at all.
More about sacroiliac joint injection
We consider a cortisone injection for the sacroiliac joint to treat inflammation and pain. However, the sacroiliac joint is deep and narrow, so we require imaging to administer the cortisone accurately into the correct location.
More recently, we have begun using platelet-rich plasma for select cases of sacroiliac joint pain. For example, people with hypermobility or a history of trauma can suffer from sacroiliac joint dysfunction. They may benefit from 1-2 PRP injections to aid in the healing of ligaments and the joint.
Traditionally, we use expensive X-rays with a dye for a sacroiliac joint injection. However, more recently, many doctors have been using ultrasound. Using ultrasound has several advantages, including the absence of radiation and lower costs. Moreover, recent studies suggest that the accuracy is similar whether you utilise an X-ray or an ultrasound.
Sometimes, a sacroiliac joint injection is combined with a piriformis injection, especially with mixed signs.
Frequently asked questions about a sacroiliac joint injection
Sacroiliac Joint Pain and Pregnancy: Is It Common?
Yes, SI joint pain is more common during and after pregnancy. Overall, we believe that hormonal changes during pregnancy contribute to the development of pain in this joint. Treatment principles are similar to rehab +/- an injection.
Do I need an X-ray or an MRI before injection for the sacroiliac joint?
Generally yes. Pain in the sacroiliac joint area can be caused by other factors, such as nerve compression from the lumbar spine or pelvic issues, including endometriosis or ovarian cysts. Overall, we recommend an MRI to rule out any potential sources of pain that may not be related to your current condition.
Why are sacroiliac joint injections so expensive?
Overall, it depends on how your doctor does the injection. If the injection is performed using X-ray imaging, the costs can be high due to expenses associated with the hospital room, nursing staff, and X-ray equipment. However, suppose the injection is performed under ultrasound guidance. In that case, the costs are usually significantly lower because the procedure is typically conducted in a clean office environment without the need for expensive extra equipment. Additionally, we recognise that the accuracy of ultrasound-guided injections is comparable to that of X-ray-guided injections.
I’ve been told that SI joint injections should only be done with X-rays, not ultrasounds. Is this right?
We don’t believe so. Ultrasound-guided SI joint injections are safe, accurate and less expensive than X-ray-guided injections. Moreover, you are not exposed to harmful and unnecessary radiation.
Are you sedated for a SI joint injection?
Generally, no, if using ultrasound guidance. However, we use a local anaesthetic to numb the area before injecting cortisone or PRP.
Do SI joint injections cause weight gain?
While cortisone injections have side effects, we know that intermittent injections do not cause weight gain.
How long do SI joint injections last?
The effect of an SI joint injection depends on the injectable used and the severity of the pathology in the SI joint. Generally, we expect a cortisone injection to last a few months, while a PRP injection is expected to last longer.
Psoriatic arthritis and SI joint: How can you tell it is psoriatic arthritis vs osteoarthritis?
Both inflammatory arthritis and osteoarthritis can affect the SI joint. However, the treatment for both conditions differs. Inflammatory arthritis encompasses autoimmune diseases that target specific joints, such as the sacroiliac (SI) joint. Examples of inflammatory arthritis include psoriatic arthritis and rheumatoid arthritis.
Generally, we use MRI to aid in the precise diagnosis. In inflammatory arthritis, we observe inflammation in the middle of the joint, accompanied by erosions of the joint. Rheumatoid blood tests also help.
Final word from Sportdoctorlondon about a sacroiliac joint injection
Sacroiliac joint pain is a common and under-reported cause of buttock pain. You should see a doctor who can diagnose and manage SI joint pain. Ultrasound-guided SI joint injections are as good as traditional X-ray-guided injections (but are at least half the price). Sometimes, a sacroiliac joint injection is combined with a piriformis injection to get better results.
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