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SI Joint diagnostic cortisone injection - pain not constant


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Old 10-26-2014, 01:00 PM   #1
Felicity-745
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Question SI Joint diagnostic cortisone injection - pain not constant

I have been having pain in my left hamstring/calf/buttock and recently groin/near hip crest for 1 1/2 years now. I have had 2 MRI's (2 years appart) showing the exact same thing; L4/L5 central & to the right bulge with no nerve compression. My pain is on the LEFT side. I do not believe my pain is discal in nature and after a year of physiotherapists/Drs/osteopaths and 3 physiatrists, I've finally found a 4th physiatrist who agrees that the discs are probably not the cause.

No maneuvre provokes or reproduces the pain during exams. Reflexes, strenght & sensations are the same on both sides (a clue that this is not true sciatica). Pain is worse and brought on by: Sitting or reclining (layZboy), sleeping on affected side, walking at a brisk pace, standing in same spot for long periods. I find I'm best when I am active and on my feet but cannot sit down and relax without pain relievers.

That 4th physiatrist wants to rule-out SI joint dysfunction. I have had blood tests to rule-out inflamatory conditions (all clear). I've had a nuclear medecine SI joint scan (scintigraphy -contrast dye imaging) but have not heard back yet. Next on the list is a fluoroscopy-guided cortisone injection for diagnostic purposes.The physiatrist wants to see me again 2 months after that cortisone shot to re-evaluate. I wonder wether I should proceed.

My question(s):

- Should I wait for the results of the bone scan to get the shot? I've been told sometimes the shot is actually better than imaging at diagnosing.
- Should I be "in pain" when I go for the shot? What if its a better day that day and am not at a high level of pain?

Any advice or similar experience would be much appreciated

 
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Old 10-26-2014, 09:21 PM   #2
teteri66
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Re: SI Joint diagnostic cortisone injection - pain not constant

When pain is intermittent, and when you cannot replicate the pain by activity or movement, I would think a diagnostic nerve block might be less useful than when those conditions do occur normally.

I had lots of diagnostic nerve blocks due to the inability of anyone to figure out what was causing my pain....I was given a drug that numbed the area and then told to do all those things that made my symptoms worse or caused them to act up. I kept notes and recorded when I began to have pain again. If I was painfree for awhile after the injection and it gradually came back after a certain period of time, it was assumed that the area that had been injected was a pain generator. If the results were not clear, we repeated the nerve block.

In your case, I would wait for the results of the bone scan. Perhaps you can avoid having the injection if the scan is conclusive.

If you have the injection when you are in pain, I don't think it will make any difference as far as the accuracy of the results. How would you know if the pain went away due to the medication or just because it went away?

Good luck. It is frustrating to have something causing pain that cannot be diagnosed.

 
Old 10-26-2014, 09:32 PM   #3
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Re: SI Joint diagnostic cortisone injection - pain not constant

I assume you have had a flexion/extension x-ray to check for a spondylolisthesis?

 
Old 10-27-2014, 06:16 AM   #4
Felicity-745
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Re: SI Joint diagnostic cortisone injection - pain not constant

Many thanks-
I've had "regular" X-rays of spine, MRI's (spine) and the bone scan (scintigraphy- pelvis). When they were doing the bone scan the technician also did my spine afte I told he I had disc bulges at L4-L5. So I don't know wether that will tell me something more than the MRI.

 
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discs, sacroiliac, sciatic pain, si joint



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