One of our attendings teaches that an S1 TF injection really doesn't get a bolus of steroids close to the S1 nerve root. He pushes for doing an L5-S1 IL injection instead. Yet often when I take a patient with likely S1 radiculitis and inject a little bupi and Kenalog in the foramen (2 mL), the patient gets excellent relief- at least until the end of the visit. My attending's point makes sense if you consider where the pathology compressing the S1 nerve usually occurs (L5-S1). OTOH, my experience injecting at S1 (with other attendings) makes sense in terms of where the nerve lives distally (ie. I think I'm numbing up the nerve where it turns the corner to pop out the anterior S1 foramen- but perhaps NOT putting steroid in the vicinity of the pathology). What do you think?