Sacroiliac joint injection (CT guided)

Case contributed by Dr Dai Roberts

Presentation

Posterolateral left pelvic pain. Therapeutic/diagnostic injection

Patient Data

Age: 55 years
Gender: Female
CT

CT guided left sacroiliac joint anesthetic arthrogram

The first set of images shows the radiopaque marking grid in place overlying the left sacroiliac joint for planning.  The inferior portion of the sacroiliac is targeted.

The second set of images shows the needle tip in an intra-articular position with iodinated contrast confirming the correct placement. 

Subsequent injection of steroid and local anesthetic was then administered. 

Case Discussion

The sacroiliac joints (SIJs) can be a source of posterior pelvic pain and guided injections can be useful for both diagnostic and therapeutic purposes. Fluoroscopy and CT can be both be used for SIJ guided injections. CT is preferred at many institutions, often due to the depth of the joint and variation in joint anatomy. 

Iodinated contrast, although not always used in CT-guided injections, can clearly demonstrate an intra-articular position. 

The volume of the SIJs are small, so the injectate volume should reflect this and is usually no more than 2 mL. The injectate mixture will consist of 1 mL of steroid and 0.5 mL-1 mL of local anesthetic. 

When selecting syringes, luer lock syringes are recommended to prevent syringe - needle detachment. Often the needle tip will be in the joint and no injectate can be administered. Fine needle repositing will be required whilst applying pressure to the syringe. 

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Case information

rID: 74191
Published: 1st Apr 2020
Last edited: 5th Apr 2020
Inclusion in quiz mode: Included
Institution: St. Paul's Hospital

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