Ultrasound-Guided Cortisone Injections for Sacroiliac Joint Pain

 

Introduction

The sacroiliac (SI) joint is a crucial structure in the lower back, responsible for transmitting forces between the spine and pelvis. It plays an essential role in stability and movement, yet it can also be a source of persistent pain and discomfort. Sacroiliac joint pain can arise from various causes, including trauma, arthritis, inflammation, or mechanical stress.

Ultrasound-guided cortisone injections have been utilised as a technique to help in the management of SI joint pain. By delivering corticosteroid medication directly into the affected joint, the procedure aims to address inflammation and discomfort. This blog provides a detailed overview of the sacroiliac joint, its anatomy, pathology, and how ultrasound-guided cortisone injections work.

Sacroiliac Joint Pain

Anatomy of the Sacroiliac Joint

The sacroiliac joint is a paired structure located between the sacrum (the triangular bone at the base of the spine) and the iliac bones of the pelvis. Each SI joint is held together by strong ligaments and has a limited range of motion, primarily functioning to absorb shock and distribute mechanical forces during movement.

Key anatomical components of the SI joint include:

  • Sacroiliac Ligaments — These strong bands of connective tissue provide stability and limit excessive movement.
  • Articular Cartilage — The surfaces of the sacrum and iliac bones are covered with cartilage that allows smooth articulation.
  • Joint Capsule — A fibrous envelope that encloses the joint, containing synovial fluid that helps in lubrication.
  • Surrounding Musculature — Several muscles, including the gluteus maximus and piriformis, contribute to SI joint function and stability.

Pathology of Sacroiliac Joint Dysfunction

Sacroiliac joint dysfunction refers to any condition that leads to pain or abnormal function of the joint. This can be caused by:

  • Inflammation (Sacroiliitis) — Inflammatory conditions such as ankylosing spondylitis can affect the SI joint, leading to pain and stiffness.
  • Degenerative Changes — Osteoarthritis or wear and tear can cause deterioration of the joint’s cartilage, resulting in discomfort.
  • Trauma — Falls, direct impact injuries, or repetitive stress can contribute to SI joint dysfunction.
  • Pregnancy and Hormonal Changes — Increased laxity of the SI ligaments during pregnancy can lead to instability and discomfort.
  • Postural and Mechanical Stress — Prolonged standing, improper lifting techniques, or gait abnormalities can place excessive strain on the SI joint.

Symptoms of Sacroiliac Joint Pain

Individuals with SI joint pain may experience:

  • Localised pain in the lower back, buttocks, or hips
  • Pain that worsens with prolonged standing, walking, or sitting
  • Discomfort when transitioning from sitting to standing
  • Referred pain down the leg, sometimes mimicking sciatica
  • Stiffness and reduced mobility in the lower back or pelvic region

Diagnosis of SI Joint Dysfunction

Diagnosing SI joint pain involves a combination of clinical assessment, medical history, and imaging techniques. Common approaches include:

  • Physical Examination — Clinicians may perform specific tests, such as the FABER test (Flexion, Abduction, and External Rotation) or Gaenslen’s test, to assess SI joint involvement.

Management Options for Sacroiliac Joint Pain

A variety of treatment strategies can be used to manage SI joint pain, including:

  • Activity Modification — Avoiding activities that exacerbate pain.
  • Bracing — SI belts can provide additional support and stability.
  • Ultrasound-Guided Cortisone Injections — This procedure aims to address inflammation within the joint.

Ultrasound-Guided Cortisone Injections for the SI Joint

Overview of the Procedure

Ultrasound-guided cortisone injections involve the use of high-frequency sound waves to visualise the SI joint in real time, allowing precise administration of corticosteroid medication.

Procedure Steps

  1. Patient Positioning — The patient is typically positioned on their stomach or side to allow optimal access to the SI joint.
  2. Ultrasound Guidance — A clinician uses an ultrasound probe to identify the exact location of the joint.
  3. Sterile Preparation — The skin over the injection site is cleaned to maintain sterility.
  4. Local Anaesthetic Administration — A small amount of anaesthetic is used to numb the area.
  5. Corticosteroid Injection — A thin needle is guided into the SI joint under ultrasound imaging, and a combination of corticosteroid and local anaesthetic is administered.
  6. Post-Procedure Monitoring — The patient is observed for a short period before discharge.

Mechanism of Action of SI Joint Injections

Corticosteroids are anti-inflammatory medications that work by:

  • Reducing Inflammatory Mediators — Cortisone inhibits the production of substances that contribute to inflammation.
  • Suppressing Immune Response — By limiting immune activity, corticosteroids help in managing inflammation within the joint.
  • Altering Pain Signalling — The injection may interfere with pain pathways, leading to relief.
  • Reducing Joint Swelling — Cortisone can help in minimising fluid accumulation within the joint capsule.

Benefits of Ultrasound-Guided SI Joint Injections

Ultrasound guidance enhances the accuracy of cortisone injections by ensuring precise placement of the medication into the joint space. The benefits include:

  • Real-Time Visualisation — Direct imaging allows clinicians to accurately target the SI joint.
  • Avoidance of Neurovascular Structures — Ultrasound guidance reduces the likelihood of complications.
  • Minimally Invasive Approach — The procedure is performed through a small needle puncture, with no need for surgical intervention.

Considerations After the Procedure

Following the injection, patients may be advised to:

  • Rest for a short period to allow the medication to take effect.
  • Gradually resume normal activities while avoiding excessive strain on the SI joint.
  • Monitor for any changes and attend follow-up appointments as recommended.

Why Choose Alton Pain Clinic for SI Joint Injections?

At Alton Pain Clinic, we provide ultrasound-guided procedures tailored to patient needs. The use of advanced imaging techniques allows for precise administration of treatments. Our clinicians are experienced in managing joint-related conditions, offering a multidisciplinary approach to care.

Conclusion

Sacroiliac joint pain can significantly impact daily activities, and an ultrasound-guided cortisone injection is a technique that can be used in managing inflammation. By delivering corticosteroid medication directly into the joint, this procedure aims to address discomfort while minimising potential complications. Alton Pain Clinic offers this approach in a clinical setting where patient care and precision are prioritised.

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