Use of Diagnostic Injections to Evaluate Sacroiliac Joint Pain

The sacroiliac joint is a complex, variable, and irregular structure, thought to be the source of 15% to 30% of low back, pelvic, and radicular pain. Several predisposing factors, including prior spinal surgery and particularly lumbar fusion, can contribute to joint inflammation and acceleration of joint degeneration. Evaluation of the sacroiliac joint as a pain generator using history and physical alone can prove difficult, because a number of other pathologies can have a similar presentation. Whereas a number of tests are used to examine the joint, no single test alone has proven validity. Imaging alone has also not been proven efficacious, particularly in nonspondyloarthropathy-mediated pain. Although no "gold standard" exists, diagnostic sacroiliac joint block has been shown to be a useful confirmatory tool in assessing sacroiliac (SI) joint-mediated pain. Sacroiliac joint injection with local anesthetic and steroids can be used as a possible therapeutic endeavor to manage pain and inflammation.