Cortisone injections into the Sacroiliac Joints (SI Joints) and Trochanteric Bursitis

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SI joint pain
Typical sites of SI Joint Pain

I finally got some cortisone shots into my spine.  I know, I’m obsessed with spinal stuff lately.

My referral asked for shots into the facet joints from L3 down and the SI joints.  The radiologist talked to me about it and refused to do that many.

I was expecting this, and I do understand his reasoning, being that he may not need to inject ALL of those joints to achieve pain relief.  And it’s safer to inject a few, then come back and do a few more, until we achieve a pain free, or low pain state.

What he doesn’t understand is that by the time we get through that process, the original joints will no longer be salved by cortisone and will be hurting again. So it’s an endless process, and I am never pain free, or even close.  It’s like painting the Harbour Bridge.

Never the less, he’s the doctor and the man with the needle and the good drugs, so I didn’t argue.  He took a look and said he also saw Trochanteric Bursitis and asked me whether my hips hurt.

I wanted to look him in the eye and give him my best Mae West impersonation and say ‘Honey, I have Rheumatoid Arthritis, EVERYTHING hurts’ but I didn’t think that would go down too well.  Plus, I need to practice my drawl more.

Aaaanyway.  I said, yes they do hurt.  I also told him my groin/hip area hurts as well, and my knees but he shushed me.  Ok.

He asked if I could lie on my hips at night.  I said I could, but it’s not comfortable, and I usually sleep on my back now.  He said he could see the bursa were inflamed and that would explain the outer hip and knee pain.  So he said he’d inject both bursa as well. Yay!

Usually doctors will only do EXACTLY what is written on the referral.  There was nothing about my hips or Trochanteric Bursitis on that piece of paper, yet this man was prepared to treat it anyway. I might be in love…

He then asked about my back pain.  Where did it hurt?  I showed him, and described the shooting pains I get down the sides of my legs…to the knee, to the ankle, I’m not sure. It differs.  I also told him about the numbness in my feet, and that climbing stairs is very difficult.  Not only painful, but my legs feel like they are made of lead. It’s hard work to lift them.  Getting into my car is difficult, lifting my leg that high.  I mentioned the buttocks pain. I even kept a straight face when I said ‘buttocks’.

He then poked and prodded a bit more, and told me he thought the source of most of the pain was probably the Sacroiliac (SI) joints.  So he’d inject both of those joints and both bursae and then we’d see how things were after that.

I agreed enthusiastically.

sacroiliac jointMy SI joints are the source of a lot of pain, and SI joint pain is the hallmark of Ankylosing Spondylitis.  Rheumatoid Arthritis is not supposed to affect the lumbar spine or SI joints.  Because my SI joints have not fused, one of my rheumatologists said that more correctly my diagnosis is Undifferentiated Spondylitis.  Because ‘Ankylosing’ means ‘fusing’ and my joints are not (yet) fused.  OK. Fine.  Pick your Spondylitis.  I have it, and the man with the cortisone can treat it. Let’s do it!

First they inject local anesthetic, and then cortisone. So relief is immediate if they hit the right spot, because the local anesthetic acts immediately.

I hadn’t realised how much my SI joints were hurting.  Cos now they don’t anymore!  I am in love. But now it’s the anesthetic that has won my heart.  Fickle, aren’t I?

Unfortunately, my lumbar facet joints still DO hurt, and I still have referred pain through my buttocks (ok, I’ll admit it, I just wanted to use the word ‘buttocks’ again).

This IS helpful information though, and it was exactly his point.  I’ll go back to my GP next week and ask for another referral. To get L4/5 and L3/4 injected and then wait for another appointment with this guy.  Hopefully the wait won’t be too long.  He was lovely, and talked to me like a person, and I’m glad I didn’t give him my sarcastic Mae West gag.

He was also right. Because now that the SI joint pain is gone I can feel exactly where the lumbar pain is.  And it’s literally a pain in the butt.  And there is a deep, central ache in my lower back.

SI joint pain
Typical sites of SI Joint Pain

When everything’s hurting it’s really hard to nail down which bit hurts most. Or even point to it. Plus, with the lower spine, referred pain is common and it’s hard to track down which pain is caused by what thing.  For now, I’ve got partial relief and that’s a good thing.  Over the next week or two, I’ll see how effective the cortisone is.  I have to rest for a few days, not much walking and definitely no gym.

And for once I’m good with that.  I’m taking the rest option.  Walking has become very difficult.  Also the pins and needles and numbness have become more than unpleasant.  And I need to know if they are the result of a trapped nerve in my spine or a neurological problem in my brain.

I see my neurologist to review my latest brain MRI in two weeks, and I’ll have both lots of information and lots of question for him by then.

3 COMMENTS

  1. I’m so glad you have some relief. I have recently started to have the SI joint pain which I mentioned to my rheumy this week, he checked me out thoroughly but doesn’t want to do any imaging yet, it’s very early days with this kind of pain and he wants me to try some yoga first to try and build up those muscles. He said PT, I said I’d prefer to do yoga at home, he was good with that. He also said it could be caused by my gait being off because I have constant hip pain & use a cane. So I’m going with what he says and trying other things first.
    I have also had the injections for the trochanteric bursitis, worst part of that is when they press and prod to find the exact spot for the needle! I also found out that yoga is brilliant for easing that too. I chickened out of the jabs last time as I’d been poked enough already and the stretching really seemed to help, if you’re into that you might want to try it when your injections have settled in. Hope the jabs work a treat.

  2. Thanks Gillian, I have been doing yoga/pilates for years. Admittedly I’m taking a break from it at the moment. I’m just having to drag myself there, and not enjoying it right now, so I think a break will do me good. I need to have one now anyway, so maybe next week! You’re right though – yoga helps a lot! Strengthening, lengthening and supporting all our weakened joints, particularly the core, with spinal issues. Personally I think everyone should try it. You can do it at any fitness level. Sometimes the pain is too great, however. But most days you can do some moves. Your rheumy sounds like a good one :).

  3. I had an MRI and I see the doctor on Monday for the answer about how to proceed. I know my SI joint hurts so bad I can barely stand it. It has for months and just gets worse and worse. I am glad I know you are doing well. Lets both get better together

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