Sacroiliac Joint Injection

What is Sacroiliac Joint Injection for?

Sacroiliac (SI) joint injection is a procedure to inject a numbing medicine (anesthetic block)—and sometimes a strong anti-inflammatory medicine (steroid)—into the SI joint.

The SI joint is the joint between two bones of the pelvis called the sacrum and the ilium. The sacrum is the bone at the base of the spine. The ilium is the large bone that forms the hip.

You may need this procedure if you have pain because of an inflamed or diseased SI joint. Various conditions can cause pain in the SI joint, including rheumatoid arthritis, gout, psoriatic arthritis, infection, or injury. SI joint pain is a common cause of low back pain. It may also cause pain in your buttock or leg.

SI joint injection may be done to:

  • Find out if an anesthetic block relieves pain. This can confirm that the SI joint is the cause of pain (diagnostic use).
  • Treat a painful SI joint with steroids, anesthetic medicine, or both (therapeutic use).

Tell a health care provider about:

  • Any allergies you have.
  • All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
  • Any problems you or family members have had with anesthetic medicines.
  • Any blood disorders you have.
  • Any surgeries you have had.
  • Any medical conditions you have.
  • Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

  • Infection.
  • Bleeding.
  • Nerve injury.
  • Temporary increase in pain.
  • Headache.
  • Failure of the procedure to relieve pain.
  • Bruising or soreness at the joint, in deep tissues, or at the injection site.
  • Allergic reactions to medicines or dyes.
  • Side effects from the steroid medicine. These may include facial flushing, increased appetite, diarrhea, and increased blood sugar.

What happens before the procedure?

  • You may have a physical exam.
  • You may have imaging tests, such as an X-ray, CT scan, or MRI.
  • Ask your health care provider about:
    • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
    • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
    • Taking over-the-counter medicines, vitamins, herbs, and supplements.
  • Plan to have someone take you home from the hospital or clinic.

What happens during the procedure?

  • To lower your risk of infection:
    • Your health care team will wash or sanitize their hands.
    • Your skin will be washed with a germ-killing (antiseptic) solution.
  • You may be given one or more of the following:
    • A medicine to help you relax (sedative).
    • A medicine to numb the area (local anesthetic). Your health care provider will inject a local anesthetic into the skin above your SI joint.
  • You will be placed in the proper position on a procedure table to give the health care team the best access to your SI joint.
  • An X-ray machine that produces moving X-ray images (fluoroscopy) will be placed above the procedure table.
  • A long, thin needle will be inserted through your skin and down to your SI joint.
  • The position of the needle will be checked with fluoroscopy imaging.
  • An X-ray dye (contrast media) will be injected to make sure the needle enters the joint space. You may be asked if you feel any pain.
  • Long-acting anesthetic medicine will be injected. Long-acting steroid medicine may also be injected.
  • The needle will be removed, and a bandage will be placed over the injection site.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

  • Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
  • If dye was used, you will be told to drink plenty of water to wash (flush) the dye out of your body.
  • You may be asked if you have pain relief from the injection.
  • You will likely be able to go home shortly after the procedure.
  • Your health care provider will give you instructions for taking care of yourself after the procedure. These may include instructions for doing physical therapy exercises.
  • Do not drive for 24 hours if you were given a sedative during the procedure.

Summary

  • A sacroiliac (SI) joint injection is an injection of a numbing medicine (anesthetic block)—and sometimes a strong anti-inflammatory medicine (steroid)—into the SI joint.
  • You will be awake during the procedure, but the injection area will be made numb.
  • If you were given a medicine to help you relax (sedative during the procedure, do not drive for at least 24 hours.

Sacroiliac Joint Injection, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have bruising or soreness at the injection site.

Follow these instructions at home:

Managing pain and swelling

  • Keep a record of your pain (pain log) to share with your health care provider at your follow-up visit. If a long-acting anti-inflammatory medicine (steroid) was included in your injection, you may not notice an improvement in your pain level for a few days.
  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Do not use a heating pad and do not apply heat directly to the area after the procedure.
  • Ask your health care provider about using cold therapy.
  • If directed, put ice on the affected area.
    • Put ice in a plastic bag.
    • Place a towel between your skin and the bag.
    • Leave the ice on for 20 minutes, 2–3 times a day. Do not use cold therapy for more than 24 hours.
  • Check your injection site every day for signs of infection. Check for:
    • Redness, swelling, or pain.
    • Fluid or blood.
    • Warmth.
    • Pus or a bad smell.

Activity

  • Rest the day of your injection. Avoid doing a lot of activity on the day of the procedure.
  • Avoid any activities that take a lot of effort for 24 hours after the injection.
  • Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
  • Do physical therapy exercises as told by your health care provider or physical therapist. These exercises are used to strengthen muscles surrounding the SI joint, and that will help to relieve pain.

General instructions

  • If dye was used during your procedure, drink plenty of water to flush the dye out of your body.
  • Do not take baths, swim, or use a hot tub until your health care provider approves. You may take showers.
  • Do not drive for 24 hours if you were given a medicine to help you relax (sedative) during your procedure.
  • Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • Your pain does not improve or it gets worse.
  • You have numbness, tingling, or weakness.
  • You have a fever.
  • You have redness, swelling, or pain around your injection site.
  • You have fluid or blood coming from your injection site.
  • Your injection site feels warm to the touch.
  • You have pus or a bad smell coming from your injection site.

Get help right away if:

  • You have chest pain or shortness of breath.

Summary

  • After the procedure, it is common to have bruising or soreness at the injection site.
  • Keep a record of your pain (pain log) to share with your health care provider at your follow-up visit.
  • Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
  • Contact your health care provider if you have pain that is getting worse, weakness, numbness, or any sign of infection at your injection site.
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