algosdoc

algosdoc
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Reg Anesth Pain Med. 2008 Jan-Feb;33(1):36-43.

Nociceptive nerve fibers in the sacroiliac joint in humans.

Szadek KM, Hoogland PV, Zuurmond WW, de Lange JJ, Perez RS.

Department of Anesthesiology, VU University Medical Center, Amsterdam, The
Netherlands. [email protected]

BACKGROUND AND OBJECTIVES: A positive response to sacroiliac joint
intra-articular infiltration with local anesthetics is used to confirm sacroiliac
joint pain. However, current anatomical and histological knowledge concerning the
anatomy of pain perception within the sacroiliac joint intra- and peri-articular
structures is insufficient to explain the efficacy of this infiltration, because
of the use of unspecific histochemical visualization techniques. METHODS: In this
study, immunohistochemistry for calcitonin gene-related peptide (CGRP) and
substance P was used to trace nociceptive fibers and receptors in the anterior
and interosseous sacroiliac ligaments obtained from 5 human cadavers without
history of sacroiliac joint pain. RESULTS: Microscopic analysis of stained slides
showed presence of CGRP and substance P immunoreactive fibers. Thick, wavy,
formed bundles were observed in dense and loose connective tissue, whereas
single, beaded nerve fibers, occasionally ramified, were observed more frequently
in the dense connective tissue and next to blood vessels. Based on their
morphologic features, these immunoreactive structures were classified as
receptors type IV. Additionally, receptors type II were found in anterior and
interosseous ligaments, which contained CGRP or substance P immunoreactive free
nerve endings. CONCLUSIONS: We conclude that the presence of CGRP and substance P
immunoreactive fibers in the normal anterior capsular ligament and interosseous
ligament provides a morphological and physiological base for pain signals
originating from these ligaments. Therefore, diagnostic infiltration techniques
for sacroiliac joint pain should consider extra- as well as intra-articular
approaches.
 

lobelsteve

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This could be used as an argument for non-fluoro SIJ injections, since you need to be extracapsular as well as intracapsular.

Lidoderm would do the trick- it's extracapsular.

Of course mine are FGCESIJI and if it does not help, I look elsewhere for a generator. If I cannot find one- I have blamed the anterior capsule in the past. But I'm still not sticking a needle through the belly to get there.
 

Tenesma

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well considering that the capsule has a hole in it anteriorly - you could assume that you will have some antral spread of your meds anyway...

the SIJ capsule is not whole to begin with.
 
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Mister Mxyzptlk

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This fits with own observations that IA plus ligamentous injection for SI pain works better than just IA. I routinely inject some medication as I withdraw back through the ligaments.

How come people report such glowing results with just posterior RF of the joint? Seems to me they are missing the entire anterior capsule.

Lobelsteve - do you really think lidoderm can penetrate that far or was that tongue in cheek? Personally I think any response to lidoderm for something other than the skin is probably due to systemic absorption.
 

Tenesma

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i have seen lidoderm do well on my skinny little patients BMI <5....

i have tried the SI RF route... either it didn't work, or patients reported the dreaded 10% improvement ... basically useless, and I have tried all kinds of different ways of (trying) to make it work... the reality is that we don't understand the innervation too well (despite our friend Yin's attempts) or at least we can't convert our understanding of the innervation into tactical solutions... the anterior coverage ain't working --- Medtronic rep was telling me of ortho dude doing sacral (tined) leads over SI joint for periph stim w/ good results... interesting
 

Mister Mxyzptlk

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I did this a few months ago. Had a lady on the table and tried SCS for her SI joints w/o success, so I laid a couple of leads along the sacral sulcus and it worked.

Pictures are at www.angelfire.com/planet/painkillah/pix/

It's the bottom 4 pictures along with some comments. She is now about 4 months post implant.

Anyone tried subcutaneous stim, where you place some SCS leads subq along the spine? Supposedly it works for axial back pain.
 

Tenesma

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most of these leads are placed subcutaneously... in my mind that is similar to a TENS but anecdotally it appears to be workable.
 
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