Patient history and physical examination have been shown to be unreliable in the diagnosis of SI joint pain. An analgesic response to a properly performed diagnostic SI joint block is considered the most reliable test to diagnose SI joint-mediated pain. Patients with low back, buttock, or groin pain not attributed to other causes can be considered for SI joint injection. The patient is positioned in the prone oblique position to facilitate visualization of the inferior portion of the joint. A 22-gauge spinal needle is placed in the inferior aspect of the joint, and a small amount of contrast is injected to confirm needle position. Then a small amount of corticosteroid, combined with a local anesthetic, is injected (Fig. 16-10).
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