The sacroiliac joint has an anterior synovial cavity (the lower one-third) and a posterior fibrocartilaginous syndesmosis. The synovial portion is the target for diagnostic and therapeutic injection. The joint moves only a few millimetres and primarily transfers loads from the spine to the lower limb.
The SIJ synovial space is injected under CT or fluoroscopic guidance to confirm sacroiliac pain as a diagnosis and for therapeutic steroid delivery. The joint line is accessible from the posteroinferior sacral edge. Posterior SIJ fusion targets the syndesmotic portion. Gapping of the SIJ in pregnancy from relaxin-induced ligament laxity increases stress on the synovial compartment.
Inflammatory synovitis in the sacroiliac joint synovial compartment from seronegative spondyloarthropathy or degenerative arthritis producing posterior pelvic pain with weight transfer, managed with fluoroscopic injection and physiotherapy.
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