FIGURE 7.8 Sacroiliac anatomy—note the angle of insertion.
PATIENT POSITION
- Standing with back in 45 degrees of forward flexion and hands/arms supported by the examination table.
LANDMARKS
- With the patient standing up with back in forward flexion, the clinician stands directly behind the patient.
- Identify tenderness over the sacroiliac joint. Mark it with ink.
- At that site, press firmly on the skin with the retracted tip of a ballpoint pen. This indention represents the entry point for the needle.
ANESTHESIA
- Local anesthesia of the skin using topical vapocoolant spray.
EQUIPMENT
- 5-mL syringe
- 25-gauge, 1½ or 2 in. needle
- 3 mL of 1% lidocaine without epinephrine
- 1 mL of the steroid solution (40 mg of triamcinolone acetonide)
- One alcohol prep pad
- Two povidone–iodine prep pads
- Sterile gauze pads
- Sterile adhesive bandage
TECHNIQUE
1. Prep the insertion site with alcohol followed by the povidone–iodine pads.
2. Achieve good local anesthesia by using topical vapocoolant spray.
3. Position the needle at a 30-degree angle laterally, relative to the sagittal plane, and 15 degrees inferiorly, relative to the transverse plane, with the tip of the needle directed toward the sacroiliac joint.
4. Using the no-touch technique, introduce the needle at the insertion site (Fig. 7.9).
5. Advance the needle slowly and carefully into the SI joint.
6. Inject the steroid solution as a bolus into the sacroiliac joint. The injected solution should flow smoothly into the space. If increased resistance is encountered, advance or withdraw the needle slightly before attempting further injection.
7. Following injection of the corticosteroid solution, withdraw the needle.
8. Apply a sterile adhesive bandage.
9. Reexamine the sacroiliac joint in 5 min to confirm pain relief.
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