Image-Guided Intra-Articular Versus Periarticular Injection in Sacroiliac Joint Pain

Sacroiliac joint (SIJ) pain is a common cause of chronic low back pain that can arise from within the joint itself or from the surrounding ligaments and supporting soft tissues. Image-guided injections using corticosteroids and local anesthetics are widely used to treat SIJ pain when physical therapy or medications fail. However, it remains uncertain whether administering the injection directly inside the joint space (intra-articular) or into the surrounding posterior ligaments (periarticular) provides greater early pain relief and functional recovery.

The primary purpose of this clinical trial is to compare the efficacy, safety, and functional outcomes of fluoroscopy-guided intra-articular versus periarticular injections in adult patients with chronic sacroiliac joint pain.

Participants are randomly assigned in a 1:1 ratio to receive one of two fluoroscopy-guided procedures:

* Intra-Articular Injection Group: Participants receive an injection of methylprednisolone acetate and bupivacaine delivered directly into the synovial space of the sacroiliac joint under fluoroscopic guidance, confirmed with radiographic contrast. * Periarticular Injection Group: Participants receive an injection of methylprednisolone acetate and bupivacaine deposited along the posterior sacroiliac ligament complex and outer capsule under fluoroscopic guidance.

All participants are followed for 8 weeks after the procedure. Changes in pain intensity are tracked using the Numeric Rating Scale (NRS) at baseline, 2 weeks, 4 weeks, and 8 weeks. Physical function and daily activity impairment are measured using the Oswestry Disability Index (ODI) at baseline, 4 weeks, and 8 weeks. Patient global improvement, side effects, and rescue pain medication consumption will also be monitored throughout the study period.

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Key information

Conditions

Sacroiliac Joint Pain Back Pain Low Back Pain Neurologic Manifestations Pain Pathological Conditions, Signs and Symptoms Sacroiliac Joint Dysfunction Signs and Symptoms

Age range

18 year–70 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

Adult patients aged 18 to 70 years
Clinical diagnosis of sacroiliac joint (SIJ) pain confirmed by at least 3 positive provocation tests out of 5 (FABER, Gaenslen's, thigh thrust, compression, or distraction tests)
Chronic SIJ pain with a symptom duration of at least 3 months
Pain intensity score of at least 4 out of 10 on the Numeric Rating Scale (NRS ≥ 4/10) at enrollment
Failure of conservative management (physiotherapy and/or NSAIDs for at least 6 weeks)
Willingness and ability to provide written informed consent

Exclusion criteria

Known coagulopathy or current anticoagulant therapy that cannot be safely bridged
Active local infection at the injection site or systemic infection
Known hypersensitivity or allergy to corticosteroids, local anesthetics, or contrast media
History of prior SIJ surgery or joint fusion
Previous sacroiliac joint injection within the last 3 months
Pregnancy or breastfeeding
Severe spinal or pelvic deformity preventing safe and accurate needle placement
Significant cognitive impairment precluding informed consent or reliable outcome reporting
Active malignancy involving the pelvis or sacrum

Treatment and study plan

Fluoroscopy-Guided Intra-Articular SIJ Injection

Procedure

Under continuous C-arm fluoroscopic guidance (15-25° ipsilateral oblique view), a 22-gauge spinal needle is advanced into the synovial cavity of the lower third of the sacroiliac joint using a posteroanterior approach. Proper intra-articular needle position is verified by injecting 0.5-1 mL iohexol contrast medium to confirm an arthrogram pattern. A 3 mL injectate consisting of methylprednisolone acetate 40 mg (1 mL) and bupivacaine 0.25% (2 mL) is then administered.

Fluoroscopy-Guided Periarticular SIJ Injection

Procedure

Under fluoroscopic guidance, a 22-gauge spinal needle is directed toward the posterior capsular region and posterior sacroiliac ligament complex overlying the middle and upper thirds of the joint. Correct placement is confirmed via contrast injection showing spread along the posterior capsular surface without intra-articular entry. An injectate of up to 5 mL containing methylprednisolone acetate 40 mg (1 mL) and bupivacaine 0.25% is deposited in a fan-like distribution.

Primary outcomes

Change from Baseline in Pain Intensity on the Numeric Rating Scale (NRS) at 4 Weeks

Time frame: Baseline and 4 weeks post-injection

Pain intensity is assessed using an 11-point Numeric Rating Scale (NRS), where scores range from 0 to 10 (0 = "no pain", 10 = "worst imaginable pain"). This measure evaluates the change in pain score from baseline to 4 weeks post-procedure. A greater reduction or lower score indicates greater pain relief.

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Sponsors and collaborators

Lead sponsor

Assiut University

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Registry information

Official study title

Image-Guided Intra-Articular Versus Periarticular Injection in Sacroiliac Joint Pain: A Comparative Study of Early Pain Outcomes

Important dates

Study start: 2026
Primary completion: 2027
Study completion: 2027
First posted: Sep 22, 2026
Registry last updated: Sep 22, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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