Ultrasound-Guided Cortisone Injections and Hyaluronic Acid Injection for the Sacroiliac Joint

 

Introduction to the Sacroiliac Joint

The sacroiliac (SI) joint plays a pivotal role in the human body by connecting the sacrum — the triangular bone at the base of the spine — with the ilium of the pelvis. Despite being a relatively small and stable joint, the SI joint bears substantial loads, distributing the forces between the upper and lower body. Dysfunction in this joint can lead to pain and mobility issues, making it a significant concern for individuals experiencing lower back discomfort.

Anatomy of the Sacroiliac Joint

The SI joint is a synovial joint, supported by robust ligaments and a thin layer of cartilage that facilitates minimal movement. Its key components include:

  1. Articular Surfaces: The sacral and iliac surfaces are covered by cartilage, with hyaline cartilage on the sacrum and fibrocartilage on the ilium.
  2. Ligaments: Several ligaments provide stability, including the anterior sacroiliac ligament, interosseous ligament, and posterior sacroiliac ligament.
  3. Muscles: Surrounding muscles, such as the gluteus maximus and piriformis, indirectly support the joint.
  4. Nerve Supply: Innervation primarily comes from the sacral spinal nerves, contributing to its complex pain referral patterns.

Pathology of Sacroiliac Joint Dysfunction

SI joint dysfunction encompasses a range of conditions causing pain and limited mobility. These include:

  1. Inflammatory Disorders: Conditions such as ankylosing spondylitis can lead to inflammation and joint fusion.
  2. Degenerative Changes: Osteoarthritis of the SI joint can develop due to wear and tear, leading to cartilage degradation and joint stiffness.
  3. Trauma: Falls or direct impacts can cause ligament injuries or misalignment of the SI joint.
  4. Pregnancy-Related Changes: Hormonal changes during pregnancy can loosen ligaments, increasing SI joint stress.
  5. Biomechanical Factors: Asymmetry in gait or leg length discrepancies can overburden the joint, resulting in dysfunction.

Symptoms of Sacroiliac Joint Dysfunction

Common symptoms of SI joint dysfunction include:

  • Pain localised to the lower back or buttocks, often radiating to the groin or thighs.
  • Stiffness and reduced mobility, especially after prolonged periods of sitting or standing.
  • Tenderness around the SI joint upon palpation.
  • Worsened pain with activities like climbing stairs, bending, or running.

Diagnostic Approach

Diagnosing SI joint dysfunction requires a combination of clinical examination and imaging:

  1. Physical Examination:
  • Specialised tests, such as the FABER (Flexion, Abduction, External Rotation) test and Gaenslen’s test, help localise the pain to the SI joint.

2. Imaging:

  • X-rays, CT scans, or MRI may reveal structural abnormalities, inflammation, or degeneration in the SI joint.
  • Diagnostic injections using local anaesthetics can confirm the SI joint as the pain source.

Management of Sacroiliac Joint Dysfunction

Non-invasive treatments include physiotherapy, activity modification, and anti-inflammatory medications. However, when these measures fail, interventional therapies, such as ultrasound-guided cortisone and hyaluronic acid injections, can be considered.

Role of Cortisone Injections in Sacroiliac Joint Dysfunction

Cortisone injections are a common therapeutic option for SI joint pain. Administered under ultrasound guidance, they deliver a corticosteroid medication directly to the inflamed area.

Mechanism of Action

  • Anti-inflammatory Properties: Cortisone suppresses the production of inflammatory mediators like prostaglandins and cytokines, reducing swelling and discomfort.
  • Pain Modulation: By calming local inflammation, cortisone decreases pressure on surrounding nerves, providing pain relief.
  • Longevity: While not curative, cortisone injections can provide temporary relief, often lasting several weeks or months.

Benefits of Ultrasound Guidance

  • Precision: Ultrasound imaging ensures accurate placement of the needle, minimising risks.
  • Safety: Real-time imaging avoids damage to surrounding structures.
  • Improved Outcomes: Direct delivery enhances the efficacy of the medication.

Role of Hyaluronic Acid Injections in Sacroiliac Joint Dysfunction

Hyaluronic acid (HA) injections are gaining attention as a complementary therapy for SI joint issues, especially in degenerative cases.

Mechanism of Action

  • Lubrication: HA restores joint lubrication, reducing friction and wear.
  • Shock Absorption: By enhancing synovial fluid viscosity, HA cushions the joint during movement.
  • Anti-inflammatory Effects: HA inhibits inflammatory enzymes, promoting a healthier joint environment.
  • Tissue Repair: HA supports the regeneration of cartilage and soft tissues, potentially slowing degeneration.

Indications for Hyaluronic Acid Injections

  • Patients with osteoarthritis or degenerative SI joint changes.
  • Cases where anti-inflammatory therapies alone are insufficient.

Comparison of Cortisone and Hyaluronic Acid Injections

While cortisone is effective for acute inflammation, HA injections are more suited for long-term joint health and structural preservation. Combining these therapies can address both inflammation and degeneration comprehensively.

Why Choose Alton Pain Clinic?

At Alton Pain Clinic, we specialise in state-of-the-art treatments for SI joint dysfunction. Our approach includes:

  1. Expertise: Highly skilled clinicians experienced in ultrasound-guided injections.
  2. Personalised Care: Tailored treatment plans addressing individual needs.
  3. Advanced Technology: Cutting-edge imaging for precise diagnosis and intervention.
  4. Holistic Approach: Combining medical and interventional therapies for optimal outcomes.

Conclusion

Sacroiliac joint dysfunction can significantly impact quality of life, but effective treatments like cortisone and hyaluronic acid injections offer hope for relief. By targeting the root causes of pain and addressing both inflammation and degeneration, these therapies can improve mobility and comfort. Alton Pain Clinic is committed to providing expert care, ensuring that every patient receives the best possible outcomes tailored to their unique needs.

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