Sacroiliac Joint Injection

  • M.J.B. Stallmeyer
  • Gregg H. Zoarski


Sacroiliac joint injection is a minimally invasive procedure that is easily performed with either fluoroscopic or CT guidance. Diagnostic injection is helpful in identifying the etiology of back pain. Therapeutic injection provides pain relief of variable duration in appropriately selected patients.


Sacroiliac Joint Joint Injection Piriformis Muscle Calcium Pyrophosphate Dihydrate Pain Provocation Test 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Bernard TN Jr, Kirkaldy-Willis WH. Recognizing specific characteristics of nonspecific low back pain. Clin Orthop 1987;217:266–280.PubMedGoogle Scholar
  2. 2.
    Schwarzer AC, Aprill CN, Bogduk N. The sacroiliac joint in chronic low back pain. Spine 1995;20:31–37.PubMedGoogle Scholar
  3. 3.
    Maigne J, Aivaliklis A, Pfefer F. Results of sacroiliac joint double block and value of sacroiliac pain provocation tests in 54 patients with low back pain. Spine 1996;21:1889–1892.CrossRefPubMedGoogle Scholar
  4. 4.
    Rudge SR, Swanell AJ, Rose DH, Todd JH. The clinical assessment of sacroiliac joint involvement in ankylosing spondylitis. Rheumatol Rehabil 1982;21:15–20.PubMedCrossRefGoogle Scholar
  5. 5.
    Maugars Y, Mathis C, Vilon P, Prost A. Corticosteroid injection of the sacroiliac joint in patients with seronegative spondyloarthropathy. Arthritis Rheum 1992;35:564–568.PubMedGoogle Scholar
  6. 6.
    Maugars Y, Mathis C, Berthelot JM, Charlier C, Prost A. Assessment of the efficacy of sacroiliac corticosteroid injections in spondyloarthropathies: a double-blind study. Br J Rheumatol 1996;35:767–770.PubMedGoogle Scholar
  7. 7.
    François S, Guaydier-Souquieres G, Marcelli C. Acute sacroiliitis as a manifestation of calcium pyrophosphate dihydrate crystal deposition disease. A report of two cases. Rev Rheum Engl Ed 1997;64:508–512.Google Scholar
  8. 8.
    Osman AA, Govender S. Septic sacroiliitis. Clin Orthop 1995;313:214–219.PubMedGoogle Scholar
  9. 9.
    Dujardin FH, Hossenbaccus M, Duparc F, Biga N, Thomine JM. Long-term functional prognosis of posterior injuries in high-energy pelvic disruption. J Orthop Trauma 1998;12:145–150; discussion 150–151.CrossRefPubMedGoogle Scholar
  10. 10.
    Daly JM, Frame PS, Rapoza PA. Sacroiliac subluxation: a common treatable cause of low back pain in pregnancy. Fam Pract Res J 1991;2:149–158.Google Scholar
  11. 11.
    Damen L, Buyruk HM, Guler-Uysal F, Lotgering FK, Snijders CJ, Stam HJ. Pelvic pain during pregnancy is associated with asymmetric laxity of the sacroiliac joints. Acta Obstet Gynaecol Scand 2001;80:1019–1024.CrossRefGoogle Scholar
  12. 12.
    DonTigny RL. Anterior dysfunction of the sacroiliac joint as a major factor in the etiology of idiopathic low back pain syndrome. Phys Ther 1990;70:250–265.PubMedGoogle Scholar
  13. 13.
    Bernard TN Jr, Cassidy JD. The sacroiliac joint syndrome: pathophysiology, diagnosis, and management. In: Frymoyer JW, ed. The Adult Spine: Principles and Practice. 2nd ed. New York: Raven Press; 1997:2343–2366.Google Scholar
  14. 14.
    Fortin JD, Dwyer AP, West S, Pier J. Sacroiliac joint: pain referral maps upon applying a new injection/arthography technique. I: Asymptomatic volunteers. Spine 1994;19:1475–1482.PubMedCrossRefGoogle Scholar
  15. 15.
    Fortin JD, Aprill CN, Ponthieux B, Pier J. Sacroiliac joint: pain referral maps upon applying a new injection/arthrography technique. II. Clinical evaluation. Spine 1994;19:1483–1489.PubMedGoogle Scholar
  16. 16.
    Dreyfuss P, Michaelsen M, Pauza K, McLarty J, Bogduk N. The value of medical history and physical examination in diagnosing sacroiliac joint pain. Spine 1996;21:2594–2602.CrossRefPubMedGoogle Scholar
  17. 17.
    Yeoman W. The relation of arthritis of the sacroiliac joint to sciatica, with an analysis of 100 cases. Lancet 1928;2:1199–1122.Google Scholar
  18. 18.
    Slipman CW, Jackson HB, Lipetz JS, Chan KT, Lenrow D, Vresilovic EJ. Sacroiliac joint pain referral zones. Arch Phys Med Rehabil 2000;81:334–338.CrossRefPubMedGoogle Scholar
  19. 19.
    Grob KR, Neuhuber WL, Kissling RO. Die innervation des Sacroiliacalgelenkes beim Menschen (Innervation of the sacroiliac joint of the human). Z Rheumatol 1995;54:117–122.PubMedGoogle Scholar
  20. 20.
    Sakamoto N, Yamashita T, Takebayashi T, Sekine M, Ishii S. An electro-physiologic study of mechanoreceptors in the sacroiliac joint and adjacent tissues. Spine. 2001;26:E468–E471.CrossRefPubMedGoogle Scholar
  21. 21.
    Vilensky JA, O’Connor BL, Fortin JD, Merkel GJ, Jimenez AM, Scofield BA, Kleiner JB. Histologic analysis of neural elements in the human sacroiliac joint. Spine 2002;27:1202–1207.CrossRefPubMedGoogle Scholar
  22. 22.
    Solonen KA. The sacroiliac joint in light of anatomical, roentgenological, and clinical studies. Acta Orthop Scand Suppl 1957;27:1–127.PubMedGoogle Scholar
  23. 23.
    Murata Y, Takahashi K, Yamagata M, Takahashi Y, Shimada Y, Moriya H. Sensory innervation of the sacroiliac joint in rats. Spine. 2000;25:2015–2019.CrossRefPubMedGoogle Scholar
  24. 24.
    Murata Y, Takahashi K, Yamagata M, Takahashi Y, Shimada U, Moriya H. Origin and pathway of sensory nerve fibers to the ventral and dorsal sides of the sacroiliac joint in rats. J Orthop Res 2001;19:379–383.CrossRefPubMedGoogle Scholar
  25. 25.
    Sayson SC, Ducey JP, Maybrey JB, Wesley RL, Vermilion D. Sciatic entrapment neuropathy associated with an anomalous piriformis muscle. Pain 1994;59:149–152.CrossRefPubMedGoogle Scholar
  26. 26.
    Williams PL, Warwick R. The sacroiliac joint. In: Williams PL, Warwick R, eds. Gray’s Anatomy. 36th ed. Edinburgh: Churchill-Livingstone; 1980:473–475.Google Scholar
  27. 27.
    Wang M, Dumas GA. Mechanical behavior of the female sacroiliac joint and influence of the anterior and posterior sacroiliac ligaments under sagittal loads. Clin Biomech 1998;13:293–299.CrossRefGoogle Scholar
  28. 28.
    Pool-Goudzwaard AL, Kleinrensink GJ, Snijders CJ, Entius C, Stoeckart R. The sacroiliac part of the iliolumbar ligament. J Anat 2001;199(pt4):457–463.CrossRefPubMedGoogle Scholar
  29. 29.
    Egund N, Olsson TH, Schmid H, Selvik G. Movements in the sacroiliac joints demonstrated with roentgen stereophotogrammetry. Acta Radiol Diagn 1978;19:833–846.Google Scholar
  30. 30.
    Sturesson B, Selvik G, Uden A. Movements of the sacroiliac joints. A roentgen stereophotogrammetric analysis. Spine 1989;14:162–165.PubMedGoogle Scholar
  31. 31.
    Slipman CW, Sterenfeld EB, Chou LH, Herzog R, Vresilovic E. The predictive value of provocative sacroiliac joint stress maneuvers in the diagnosis of sacroiliac joint syndrome. Arch Phys Med Rehabil 1998;70:288–292.CrossRefGoogle Scholar
  32. 32.
    Bogduk N. Pain provocation tests for the assessment of sacroiliac joint dysfunction. J Spinal Disord 1999;12:357–358.PubMedGoogle Scholar
  33. 33.
    Potter NA, Rothstein JM. Intertester reliability for selected clinical tests of the sacroiliac joint. Phys Ther 1985;65:1671–1675.PubMedGoogle Scholar
  34. 34.
    Riddle DL, Freburger JK. Evaluation of the presence of sacroiliac joint region dysfunction using a combination of tests: a multicenter intertester reliability study. Phys Ther 2002;82:772–781.PubMedGoogle Scholar
  35. 35.
    Calvillo O, Skaribas I, Turnipseed J. Anatomy and pathophysiology of the sacroiliac joint. Curr Rev Pain 2000;4:356–361.PubMedGoogle Scholar
  36. 36.
    Elgafy H, Semaan HB, Ebraheim NA, Coombs RJ. Computed tomography findings in patients with sacroiliac pain. Clin Orthop 2001;382:112–118.PubMedGoogle Scholar
  37. 37.
    Slipman CW, Sterenfeld EB, Chou LH, Herzog R, Vresilovic E. The value of radionuclide imaging in the diagnosis of sacroiliac joint syndrome. Spine 1996;21:2251–2254.CrossRefPubMedGoogle Scholar
  38. 38.
    Hanly JG, Barnes DC, Mitchell MJ, MacMillan L, Docherty P. Single photon emission computed tomography in the diagnosis of inflammatory spondyloarthropathies. J Rheumatol 1993;20:2062–2068.PubMedGoogle Scholar
  39. 39.
    Hanly JG, Mitchell MJ, Barnes DC, MacMillan L. Early recognition of sacroiliitis by_magnetic resonance imaging and single photon emission computed tomography. J Rheumatol 1994;21:2088–2095.PubMedGoogle Scholar
  40. 40.
    Docherty P, Mitchell MJ, MacMillan L, Mosher D, Barnes DC, Hanly JG. Magnetic resonance imaging in the detection of sacroiliitis. J Rheumatol 1992;19:393–401.PubMedGoogle Scholar
  41. 41.
    Battafarano DF, West SG, Rak KM, Fortenbery EJ, Chantelois AE. Comparison of bone scan, computed tomography, and magnetic resonance imaging in the diagnosis of active sacroiliitis. Semin Arthritis Rheum 1993; 23:161–176.PubMedGoogle Scholar
  42. 42.
    Bollow M, Braun J, Hamm B, Eggens U, Schilling A, Konig H, Wolf KJ. Early sacroiliitis in patients with spondyloarthropathy: evaluation with dynamic gadolinium-enhanced MR imaging. Radiology 1995;194:529–536.PubMedGoogle Scholar
  43. 43.
    Bollow M, Braun J, Taupitz M, Haberle J, Reibhauer BH, Paris S, Mutze S, Seyrekbasan F, Wolf KJ, Hamm B. CT-guided intraarticular corticosteroid injection into the sacroiliac joints in patients with spondyloarthropathy: indication and follow-up with contrast-enhanced MRI. J Comput Assist Tomogr 1996;20:512–521.CrossRefPubMedGoogle Scholar
  44. 44.
    Braun J, Bollow M, Seyrekbasan F, Haberle HJ, Eggens U, Mertz A, Distler A, Sieper J. Computed tomography guided corticosteroid injection of the sacroiliac joint in patients with spondyloarthropathy with sacroiliitis: clinical outcome and followup by dynamic magnetic resonance imaging. J Rheumatol 1996;23:659–664.PubMedGoogle Scholar
  45. 45.
    Bellussi A, Busi Rizzi E, Schinina V, De Santis A, Bibbolino C. STIR sequence in infectious sacroiliitis in three patients. Clin Imaging 2002;26:212–215.CrossRefPubMedGoogle Scholar
  46. 46.
    Wittram C, Whitehouse GH, Williams JW, Bucknall RC. A comparison of MR and CT in suspected sacroiliitis. J Comput Assist Tomogr 1996;20:68–72.CrossRefPubMedGoogle Scholar
  47. 47.
    Haldeman K, Sotohall R. The diagnosis and treatment of sacroiliac conditions involving injection of procaine (Novocaine). J Bone Joint Surg Am 1938;3:675–685.Google Scholar
  48. 48.
    Dussault RG, Kaplan PA, Anderson MW. Fluoroscopy-guided sacroiliac joint injections. Radiology. 2000;214:273–277.PubMedGoogle Scholar
  49. 49.
    Slipman CW, Lipetz JS, Plastaras CT, Jackson HB, Vresilovic EJ, Lenrow DA, Braverman DL. Fluoroscopically guided therapeutic sacroiliac joint injections for sacroiliac joint syndrome. Am J Phys Med Rehabil 2001;80:425–432.CrossRefPubMedGoogle Scholar
  50. 50.
    Pulisetti D, Ebraheim NA. CT-guided sacroiliac joint injections. J Spinal Disord 1999;12:310–312.PubMedGoogle Scholar
  51. 51.
    Hanly JG, Mitchell M, MacMillan L, Mosher D, Sutton E. Efficacy of corticosteroid injections in patients with inflammatory spondyloarthropathy: results of a six-month controlled study. J Rheumatol 2000;27:719–722.PubMedGoogle Scholar
  52. 52.
    Pereira PL, Gunaydin I, Trubenbach F, Dammann F, Remy CT, Kotter I, Schick F, Koenig CW, Claussen CD. Interventional MR imaging for injection of sacroiliac joints in patients with sacroiliitis. AJR Am J Roentgenol 2000;175:265–266.PubMedGoogle Scholar
  53. 53.
    Rosenberg JM, Quint DJ, de Rosayro AM. Computerized tomographic localization of clinically-guided sacroiliac joint injections. Clin J Pain 2000;16: 18–21.CrossRefPubMedGoogle Scholar
  54. 54.
    Srejic U, Calvillo O, Kabakibou K. Viscosupplementation: a new concept in the treatment of sacroiliac joint syndrome: a preliminary report of four cases. Reg Anesth Pain Med 1999;24:84–88.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag New York, Inc. 2004

Authors and Affiliations

  • M.J.B. Stallmeyer
  • Gregg H. Zoarski

There are no affiliations available

Personalised recommendations