Background & Aims
The sacroiliac joint (SIJ) is involved in 15% to 30% of patients with lower back pain. Low back pain (LBP) is one of the most common human health problems, with a global prevalence of around 9.4%. The sacroiliac joint (SIJ) is one of the most common locations for pain that results in chronic pain. Pain in the SIJ is a common source of mechanical low back pain, but is often underdiagnosed. The incidence rate of this condition is estimated to range from 15%-30% in patients with nonradicular low back pain. Intra-articular injection using local anesthetic is considered the gold standard for diagnosing SIJ pain. Many treatment modalities are available for this condition, ranging from conservative management to surgical intervention. 1-3
Methods
This case report discusses an outpatient, a 58-year-old woman with a weight of 82 kg, height 162cm and BMI 31.14 kg/m2 who came with complaints of sacroiliac joint pain (SIJ), the patient experienced intermittent low back pain since 3 years, pain disappears when given pain medication, pain occurs when active. Patient activity as a nurse with a high intensity of patient mobilization. Patient with physical examination and laboratory results within normal limits, history of falling in the bathroom approximately 5 years ago. The patient was injected in the SIJ using Bupivacaine 0.125% as much as 10cc added with 40 mg methylprednisolone in a pronation position using ultrasound guidance. After the procedure, the analgesic Paracetamol 3x500mg orally was given with an NRS score of 0/10. This patient underwent ultrasound-guided SIJ injection using a curvilinear transducer.
Results
The Interventional management of SIJ Pain with SIJ injection can be used for diagnosis and therapy of SIJ pain. In the diagnostic block, anesthetic is injected into the SIJ, and if the patient experiences a 75% reduction in pain on provocation testing, a diagnosis of SIJ dysfunction can be made. For therapeutic purposes, a local anesthetic (lidocaine or bupivacaine) together with a corticosteroid (triamcinolone, methylprednisolone, betamethasone or dexamethasone) is injected to relieve pain in the SIJ. Therapeutic SIJ injections can be intraarticular or periarticular. Peri-articular injection involves the injection of corticosteroids and/or local anesthetics into one or more parts of the posterior ligamentous structures of the SIJ periarticular injection. The procedure of SIJ injection can be performed with the aid of fluoroscopy or ultrasound. Ultrasound-guided SIJ injection has been shown to have a high success rate of up to 90%.
Conclusions
SIJ is a complex joint, with various muscular and ligamentous structures contributing to its stability. The SIJ is responsible for 16% to 30% of complaints of low back pain and this condition is difficult to distinguish from other forms of low back pain. A number of pathological conditions can cause SIJ dysfunction, ranging from trauma, history of surgery, pregnancy, and other systemic diseases. The diagnosis of SIJ pain is sometimes difficult to make, and the clinician cannot rely solely on clinical, laboratory, and radiological examinations. Diagnostic SIJ block using different local anesthetics is the gold standard for confirming the SIJ as the source of pain. Management of this condition involves a variety of interventional therapies and rehabilitation. Currently, most scientific evidence recommends intra-articular SIJ infiltration for short-term pain relief.
References
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