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- Created: 27 November 2018
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What is Sacroiliac Joint Pain and Block
Authors: Stephanie M. Morfi, Biology, Ramapo College of New Jersey; PAIN RELIEF CENTER
About the Sacro-iliac Joint
The Sacro-iliac joints, or SI joints, connect the sacrum of the human spine to each ilium of the pelvis. The sacroiliac joints do not have a significant range of motion, but they are crucial for transferring the forces of the upper body to the lower body. Each sacroiliac joint is encased and strengthened by ligaments. However, when the ligaments of the SI joints become damaged or worn-down by age, they allow the joint to have an excessive motion which inflames and disrupts the joint. This results in sacroiliac joint disease.
Symptoms of Sacro-iliac Joint Disease
Sacro-iliac Joint Disease may include the following symptoms:
- · Lower back pain
- · Hip/Groin pain
- · Pelvis/Buttock pain
- · Sensation in lower extremities: pain, numbness, tingling, weakness
- · Feeling of leg instability (buckling; giving way; etc.)
Sacro-iliac joint disease is most commonly found in young or middle age women due to pregnancy and menopause. Individuals affected by the sacro-iliac joint disease may have disturbed sleep patterns, and have difficulty sitting, standing, or walking. Although these symptoms are most commonly experienced on one side of the body, they may occur on both sides.
Sacro-iliac joint disease is not easily diagnosed because the symptoms are frequently mistaken for other common health conditions. The pattern of pain can be similar between facet pain, sciatica, disk herniation, and sacro-iliac joint pain. Imaging tests, such as X-rays, MRIs, or CT scans, cannot clearly demonstrate the diagnosis either. A careful and thorough physical exam by a trained physician can help determine whether the pain is coming from the hip, the low back, or the sacro-iliac joint. Tenderness in the sacro-iliac joint area may indicate that there is a problem with your SI joint. A set of five physical examination maneuvers that put specific stress on the sacro-iliac joint can help narrow down the diagnosis and demonstrate that the sacro-iliac joint is the cause of the pain. These pain provocation tests include the distraction test, thigh thrust test, FABER test, compression test, and the Gaenslen test. Pain during these maneuvers may indicate that a patient is suffering from sacro-iliac joint disease. If the patient's history, physical examination, and pain provocation tests suggest the SI joint is the source of the pain, then a Diagnostic Sacro-iliac Joint Block is considered.
Most patients with sacro-iliac joint disease do not necessarily need surgery. Treatment for sacro-iliac joint disease generally focuses on restoring normal joint motion and reducing pain and inflammation. The range of treatment options available to a patient include medications, physical therapy, external support (braces or SI joint belt), therapeutic sacro-iliac joint blocks, radiofrequency ablation, minimally invasive SI joint fusion, and open SI joint fusion. Oftentimes, medication is prescribed to treat sacro-iliac joint disease. Non-steroidal anti-inflammatory drugs (NSAIDs) and pain medications may be used for short-term pain relief and to reduce inflammation of the SI joint. Physical therapy is also an excellent form of treatment as it strengthens the muscles surrounding the sacro-iliac joint, which ultimately helps increase the flexibility of the joint and reduces pain. However, the most common and effective treatment for sacro-iliac joint disease is a Therapeutic Sacro-iliac Joint Block.
Sacro-iliac Joint Block
The sacro-iliac joint block serves two purposes: to diagnose whether the SI joint is the source of a patient's pain (diagnostic SI joint block), and to provide therapeutic pain relief (therapeutic SI joint block). Both forms are nonsurgical procedures that only take several minutes and patients are able to go home the same day. Diagnostic sacro-iliac joint blocks and therapeutic sacro-iliac joint blocks follow similar initial protocols. These procedures are done under fluoroscopic guidance utilizing contrast to confirm needle placement and verify the spread of medication within the joint. First, the patient is positioned prone on the radiography table and vitals are carefully monitored. The physician uses Fluoroscopy Guided-Image Technology with a C-arm device to obtain a true lateral image of where the anterior and posterior SI joints are superimposed and be able to place the medication with a high degree of accuracy at the affected site. Then, by adjusting the C-arm until a separation between the anterior SI joint and posterior SI joint is seen, the physician anesthetizes the skin with Bupivacaine and a needle is inserted into the medial aspect of the joint. Once the needle is properly positioned within the inferior portion of the joint, a contrast medium is injected. From there, either a diagnostic SI joint block or therapeutic SI joint block with anti-inflammatory medications will take place.
For diagnostic sacro-iliac joint blocks, up to 2 ml of local anesthetics, such as Bupivacaine, may be injected. Although anesthetics do not provide long-term pain relief, they may deliver brief and immediate pain relief, which is why it is best to use for diagnostic purposes. If there is pain relief of at least 75% when observing the patient’s visual analog pain scores within the normal duration of the anesthetic, a tentative diagnosis of sacro-iliac joint disease is made. Often times, a second diagnostic sacro-iliac block may be performed using a different anesthetic, such as Lidocaine, in order to confirm the diagnosis. If the second diagnostic block also provides 75% pain relief, there is a reasonable degree of medical certainty that the patient has sacro-iliac joint disease and may consider receiving therapeutic SI joint blocks.
For therapeutic sacro-iliac joint blocks, a mixture of an anti-inflammatory medication, such as Corticosteroids, and a local anesthetic is used. With this mixture, the anesthetic provides immediate pain relief, and the anti-inflammatory medication reduces inflammation within the joint and helps alleviate the pain over a longer period of time. A therapeutic sacro-iliac joint block can definitely yield a long-term result in pain reduction. However, the anti-inflammatory effect is not permanent. They offer pain relief for one to two days or up to several months depending on the patient and the severity of the pain. If the patient experiences continued pain relief after a therapeutic sacro-iliac joint block, he or she can begin physical therapy to further reduce pain and improve their quality of life.
When patients are unresponsive to therapeutic sacro-iliac joint blocks in conjunction with physical therapy, the next step in the sacro-iliac joint disease treatment plan would be to consider radiofrequency ablation, minimally invasive SI joint fusion, or open SI joint fusion.
The sacro-iliac joint is a large joint that connects the spine to the pelvis. When the joint develops sacro-iliac joint disease, it can cause pain in its immediate region or it can refer pain into the groin, abdomen, hip, buttock or leg. The sacro-iliac joint block is quick, non-invasive, and uses Fluoroscopy Guided-Image Technology to ensure that medication is applied at a high degree of accuracy. A sacro-iliac joint block’s purpose is twofold: to diagnosis sacro-iliac joint disease, and to treat sacro-iliac joint disease. In a diagnostic sacro-iliac joint block, the amount of immediate pain relief after injecting an anesthetic into the joint helps confirm whether or not a patient has sacro-iliac joint disease. In a therapeutic sacro-iliac joint block, a mixture of anesthetic and anti-inflammatory medication is injected into the affected joint to reduce inflammation, which can provide long-term pain relief. Although there are numerous ways to treat sacro-iliac joint disease, sacro-iliac joint blocks work powerfully to reduce inflammation and provide months of pain relief.
If you or someone you know suffers from low back pain or sacroiliac joint pain that negatively interferes with the physical emotional, socio-labor and family sphere, consult us in our pain clinic to offer you the most advanced medical treatments such as image-guided injection technology for the relief and pain management of your low back pain or sacroiliac joint pain; that you can recover the optimal physical and functional abilities quickly, allowing you reintegrate with all enjoyable experiences and your socio-occupational life.
Dr. Roque has a vast and extensive experience in the mentioned field; In addition, Dr. Roque's Pain Relief Center, located at 543 45th St. Union City NJ - Telephone 201-766-6469 - is fully equipped with innovative cutting-edge equipment and technology required to practice this type of procedures safely and effectively.