Ultrasound-Guided Cortisone Injections for Sacroiliac Joint Dysfunction

 

Introduction

The sacroiliac joint, often referred to as the SI joint, is a small but vital structure located at the base of the spine where the sacrum meets the pelvis. Though relatively immobile compared to other joints, it plays a crucial role in stabilising the spine, transferring weight between the upper body and legs, and absorbing impact during movement.

When the sacroiliac joint becomes irritated or dysfunctional, it can cause pain in the lower back, buttocks, hips, or even radiating into the legs. This is known as sacroiliac joint dysfunction.

At Joint Injections, one of the available management strategies for sacroiliac joint dysfunction includes ultrasound-guided cortisone injections. These injections, performed by experienced clinicians, are delivered with precision to target inflammation within the joint under direct imaging guidance.

This blog provides an in-depth look at sacroiliac joint dysfunction — from anatomy and pathology to symptoms, diagnosis, and management — and explains how ultrasound-guided cortisone injections work.

Anatomy of the Sacroiliac Joint

The sacroiliac joint is located where the sacrum — the triangular bone at the base of the spine — meets the iliac bones of the pelvis. Humans typically have two sacroiliac joints, one on each side.

Key anatomical features include:

  • Sacrum — A triangular bone formed by fused vertebrae, located just above the coccyx.
  • Ilium — The large, wing-shaped bone forming the upper part of the pelvis.
  • Joint Surfaces — Irregular, interlocking surfaces lined with cartilage that provide stability.
  • Ligaments — Strong bands such as the anterior sacroiliac ligament, posterior sacroiliac ligament, and interosseous sacroiliac ligament reinforce the joint.
  • Nerve Supply — Nerves from the lumbosacral plexus provide innervation, which explains why pain may radiate beyond the joint.

The sacroiliac joint is designed more for stability than mobility. Its function is to absorb shock and distribute forces during standing, walking, and lifting. Even small disturbances can trigger inflammation and pain.

Pathology of Sacroiliac Joint Dysfunction

Sacroiliac joint dysfunction occurs when there is either too much movement (hypermobility) or too little movement (hypomobility) in the joint, or when the joint surfaces become irritated.

Pathological processes may include:

  • Inflammation of joint structures (sacroiliitis).
  • Mechanical strain from repetitive movements or prolonged postures.
  • Degenerative changes in the cartilage.
  • Post-traumatic injury to the pelvis or lower back.
  • Hormonal effects (e.g., pregnancy-related ligament laxity).

Over time, abnormal joint mechanics can lead to local irritation, secondary muscle spasm, and altered movement patterns, all of which contribute to persistent discomfort.

Symptoms of Sacroiliac Joint Dysfunction

Common symptoms include:

  • Localised pain in the lower back or buttocks.
  • Pain that radiates to the groin, hips, or thighs.
  • Worsening pain with standing, climbing stairs, or prolonged sitting.
  • Stiffness and reduced flexibility.
  • Pain aggravated by transitional movements such as standing from sitting.

Symptoms may mimic other spinal or hip conditions, making diagnosis complex.

Causes and Risk Factors

Several factors may predispose an individual to sacroiliac joint dysfunction, such as:

  • Previous injury to the pelvis or spine.
  • Repetitive strain or heavy lifting.
  • Leg length discrepancy.
  • Pregnancy, due to hormonal changes affecting ligament laxity.
  • Degenerative joint disease.
  • Previous lumbar spine surgery altering mechanics.

Diagnosis

Diagnosis of sacroiliac joint dysfunction requires careful assessment by a clinician. The process may involve:

  1. Clinical History — Reviewing onset, triggers, and progression of pain.
  2. Physical Examination — Including provocative tests such as the FABER test, Gaenslen’s test, or compression tests.

Management of Sacroiliac Joint Dysfunction

Lifestyle and Activity Modification

Avoiding repetitive strain, improving posture, and using supportive devices where necessary.

Ultrasound-Guided Cortisone Injections

At Joint Injections, cortisone injections can be carried out under ultrasound guidance for precision targeting of the sacroiliac joint.

Ultrasound-Guided Cortisone Injections

Ultrasound guidance allows clinicians to visualise the sacroiliac joint in real time, ensuring accurate and safe placement of the needle.

Benefits of ultrasound guidance include:

  • Precise targeting of the joint.
  • Avoidance of nearby blood vessels and nerves.
  • Enhanced accuracy compared to landmark-based techniques.

Mechanism of Action of Cortisone

Cortisone is a corticosteroid with strong anti-inflammatory properties. When delivered into the sacroiliac joint:

  • It reduces local inflammation by calming immune system overactivity.
  • It decreases the release of pro-inflammatory chemicals.
  • It helps reduce irritation of the ligaments and joint capsule.

Role of the Clinician at Joint Injections

At Joint Injections, all procedures are performed by experienced clinicians who are highly skilled in using ultrasound guidance. Their expertise ensures that the injection is carried out safely, accurately, and tailored to each individual’s clinical presentation.

The clinician’s role is not limited to performing the injection. They also provide guidance on:

  • Identifying whether the SI joint is the source of symptoms.
  • Developing a personalised treatment plan.
  • Advising on long-term management strategies alongside injection therapy.

Why Choose Joint Injections?

At Joint Injections, patients are cared for by dedicated clinicians who use advanced imaging techniques to provide safe and precise procedures. The clinic is designed to offer a tailored, patient-centred approach for individuals seeking relief from joint-related conditions.

Summary

Sacroiliac joint dysfunction is a condition that arises when the SI joint becomes irritated, inflamed, or mechanically imbalanced. It can lead to significant discomfort in the lower back, hips, and legs, often mimicking other spinal or hip conditions.

At Joint Injections, ultrasound-guided cortisone injections are performed by experienced clinicians, ensuring accuracy and safety as part of a broader management plan tailored to the individual.


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