Sacroiliac Joint Injection - Frequently Asked Questions
What is a Sacroiliac Joint Injection?
A Sacroiliac Joint Injection is an injection of a long lasting steroid ("cortisone") in the Sacroiliac joints – which are located in the back area, as a part of the bony structure.
The steroid injected reduces the inflammation and/or swelling of tissue in the joint space. This may in turn reduce pain, and other symptoms caused by inflammation / irritation of the joint and surrounding structures.
The actual injection takes only a few minutes.
The injection consists of a mixture of local anesthetic (like lidocaine or bupivacaine) and the steroid medication (triamcinolone – Aristocort® or methylprednisolone – Depo-medrol®).
The procedure involves inserting a needle through skin and deeper tissues (like a "tetanus shot"). So, there is some discomfort involved. However, we numb the skin and deeper tissues with a local anesthetic using a very thin needle prior to inserting the needle into the joint. Most of the patients also receive intravenous sedation and analgesia, which makes the procedure easy to tolerate.
No. This procedure is done under local anesthesia. Most of the patients also receive intravenous sedation and analgesia, which makes the procedure easy to tolerate. The amount of sedation given generally depends upon the patient tolerance.
It is done with the patient lying on the stomach under x-ray control. The patients are monitored with EKG, blood pressure cuff and blood oxygen-monitoring device. The skin in the back is cleaned with antiseptic solution and then the injection is carried out. After the injection, you are placed on your back or on your side.
Immediately after the injection, you may feel that your pain may be gone or reduced. This is due to the local anesthetic injected. This will last only for a few hours. Your pain will return and you may have a "sore back or neck" for a day or two. This is due to the mechanical process of needle insertion as well as initial irritation from the steroid itself. You should start noticing pain relief starting the 5th day or so.
You should have a ride home. We advise the patients to take it easy for a day or so after the procedure. You may want to apply ice to the affected area. Perform the activities as tolerated by you.
Unless there are complications, you should be able to return to your work the next day. The most common thing you may feel is a sore back or neck.
The immediate effect is usually from the local anesthetic injected. This wears off in a few hours. The cortisone starts working in about 5 to 7 days and its effect can last for several days to a few months.
If the first injection does not relieve your symptoms in about a week to two weeks, it may be recommended that you have one more injection. If you respond to the injections and still have residual pain, you may be recommended for a third injection
In a six-month period, we generally do not perform more than three injections. This is because the medication injected lasts for about six months. If three injections have not helped you, it is very unlikely that you will get any further benefit from more injections. Also, giving more injections will increase the likelihood of side effects from cortisone.
It is very difficult to predict if the injection will indeed help you or not. Generally speaking, the patients who have recent onset of pain may respond much better than the ones with long standing pain.
Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects, and possibility of complications. The most common side effect is pain – which is temporary. The other risks involve, infection, bleeding, and worsening of symptoms. The other risks are related to the side effects of cortisone: These include weight gain, increase in blood sugar (mainly in diabetics), water retention, suppression of body’s own natural production of cortisone etc. Fortunately, the serious side effects and complications are uncommon.
If you are allergic to any of the medications to be injected, if you are on a blood thinning medication (e.g. Coumadin®), or if you have an active infection going on, you should not have the injection.