Managing Sacroiliac Pain in the Emergency Department

I have been treating specifically localized sacroiliac pain with injections of bupivacaine and methylprednisolone for several years. It seems that every few months I have a patient who presents with localized pain and can benefit from this procedure. The only patients on whom I perform these injections are those who localize their pain to the back dimples, also known as the dimples of Venus or fossae lumbales laterales.   Anatomically, it is known that beneath these dimples are the superior aspects of the sacroiliac joints. These sacral sulci are anatomically just above the posterior superior iliac spine and also the junction of the base of the sacrum with the posterior iliac crest on either side. These indentations are created by a short ligament stretching between the skin and the posterior superior iliac spine. The only ones I inject with consistent, successful pain relief are patients with low back pain localized exactly to this area. These injections are potentially going into a joint space, and must be done using excellent sterile technique.   I am pretty sure that this video may be criticized by some pain interventionalists who do sacroiliac injections using ultrasound, MRI, or fluoroscopic C-arms. A good friend of mine who happens to be a pain specialist, in fact, said in an recent email, “Generally, not a great way to do it. Hard enough to accomplish with ultrasound or C-arm imaging.” Nevertheless, my twin brother, who is also a fellowship-trained pain spec...
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