Ultrasound-Guided Cortisone Injections for Sacroiliac Joint Dysfunction

 

Introduction

The sacroiliac (SI) joint is a critical structure that links the spine to the pelvis, providing stability while allowing limited but essential movement. Dysfunction in this joint is a recognised source of pain, particularly in the lower back, buttocks, and sometimes radiating down into the legs. Sacroiliac joint dysfunction can significantly impact daily life, as it interferes with sitting, walking, standing, and even sleeping comfortably.

At Alton Pain Clinic, clinicians provide ultrasound-guided cortisone injections as one of the approaches used in managing sacroiliac joint dysfunction. This blog explores sacroiliac joint dysfunction in depth, including its anatomy, pathology, symptoms, diagnosis, and treatment options. It will also explain the role of cortisone injections, their mechanism of action, and why ultrasound guidance is an important part of the procedure.

Anatomy of the Sacroiliac Joint

The sacroiliac joints are located at the junction between the sacrum (the triangular bone at the base of the spine) and the ilium (the large wing-like bones of the pelvis). There are two sacroiliac joints, one on each side, forming strong connections that support the weight of the upper body and transfer forces to the lower limbs

  • Structure: The sacroiliac joint is a synovial joint with irregular articular surfaces, reinforced by strong ligaments such as the sacroiliac, sacrotuberous, and sacrospinous ligaments.
  • Function: It serves as a shock absorber and stabiliser, transferring forces between the upper body and legs while limiting excessive movement.
  • Innervation: The joint receives nerve supply from the lumbosacral nerve roots, which explains why dysfunction can lead to pain in multiple areas.

The stability of this joint relies on both bony architecture and strong supporting ligaments, meaning even minor disruption can lead to pain and dysfunction.

Pathology of Sacroiliac Joint Dysfunction

Sacroiliac joint dysfunction occurs when the joint becomes irritated, inflamed, or restricted in movement. It may result from a number of underlying factors:

  • Mechanical stress: Repetitive activities, prolonged standing, or uneven weight distribution.
  • Pregnancy-related changes: Hormonal influences can relax ligaments, making the joint more mobile.
  • Trauma: Falls, accidents, or sudden twists may injure the joint or supporting ligaments.
  • Degeneration: Age-related wear and tear may contribute to structural changes in the joint.
  • Inflammatory conditions: Disorders such as spondyloarthropathies can affect the sacroiliac joint.

The pathology typically involves a cycle of inflammation, joint irritation, and altered biomechanics, which contribute to ongoing discomfort.

Symptoms of Sacroiliac Joint Dysfunction

The clinical presentation of sacroiliac joint dysfunction can vary, but commonly includes:

  • Pain in the lower back, buttocks, or hips.
  • Pain radiating to the thighs or groin.
  • Stiffness or difficulty with prolonged standing or walking.
  • Discomfort when sitting for long periods.
  • Pain that worsens when climbing stairs, bending, or rising from a seated position.

The pain is often unilateral but may occur on both sides. Because symptoms overlap with other spinal and hip conditions, accurate diagnosis is essential.

Diagnosis of Sacroiliac Joint Dysfunction

Diagnosing sacroiliac joint dysfunction requires a thorough clinical assessment. Clinicians may use:

  • History and symptom analysis: Identifying pain patterns, aggravating and relieving factors.
  • Physical examination: Special tests such as the FABER (Flexion, Abduction, External Rotation) test, Gaenslen’s test, and sacral thrust test are often performed.

Accurate diagnosis ensures that treatment can be directed appropriately.

Management of Sacroiliac Joint Dysfunction

A range of management strategies are used for sacroiliac joint dysfunction, often tailored to the individual. These include:

  • Activity modification: Avoiding activities that exacerbate symptoms.
  • Medication: Oral anti-inflammatory medications may help manage pain.
  • Injections: Cortisone injections into the sacroiliac joint are one of the interventional approaches used by clinicians.

Role of Ultrasound-Guided Cortisone Injections

At Alton Pain Clinic, clinicians use ultrasound guidance when performing cortisone injections into the sacroiliac joint.

  • Precision: Ultrasound allows real-time imaging of the joint and surrounding structures, ensuring the injection is delivered with accuracy.
  • Safety: By visualising the anatomy, the clinician can avoid nearby nerves and blood vessels.
  • Comfort: Guidance reduces the need for multiple attempts, supporting a smoother procedure.

Cortisone and Its Mechanism of Action

Cortisone belongs to a group of medicines known as corticosteroids. It has properties that are useful in managing inflammation within joints.

Mechanism of Action:

Cortisone works by reducing the activity of inflammatory mediators within the joint.

  • It decreases local swelling and irritation of the tissues surrounding the sacroiliac joint.
  • By reducing inflammation, it can help ease the cycle of pain and stiffness.
  • Cortisone does not alter the structure of the joint but helps manage the inflammatory response.

When delivered directly into the sacroiliac joint under ultrasound guidance, the medicine is placed precisely where it is needed, which enhances its targeted action.

Benefits of Ultrasound Guidance at Alton Pain Clinic

At Alton Pain Clinic, ultrasound guidance is a key aspect of joint injections. For sacroiliac joint dysfunction, this means:

  • Targeted delivery of cortisone into the joint space.
  • Real-time imaging for improved procedural accuracy.
  • Minimised risk of unintended injection outside the joint.
  • Visual reassurance for both clinician and patient during the procedure.

This approach ensures that the injection is performed with attention to accuracy and care.

Why Choose Alton Pain Clinic for Sacroiliac Joint Injections?

At Alton Pain Clinic, the focus is on delivering careful and precise management for joint-related conditions, including sacroiliac joint dysfunction. Reasons to consider the clinic include:

  • Experienced clinicians with expertise in joint injections.
  • Use of ultrasound guidance for accuracy and safety.
  • Patient-centred approach, tailoring management to individual needs.
  • Comprehensive care, where injections may be combined with other appropriate management strategies.

Conclusion

Sacroiliac joint dysfunction is a significant source of lower back and pelvic pain, often interfering with everyday life. Understanding the anatomy, pathology, symptoms, and management options is essential for addressing this condition effectively.

At Alton Pain Clinic, ultrasound-guided cortisone injections are one of the interventional approaches used to support individuals with sacroiliac joint dysfunction. By reducing inflammation and providing targeted relief, these injections form part of a broader management strategy aimed at restoring function and comfort.

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