Background: The conventional technique for sacroiliac (SI) joint injection involves aligning the anterior and posterior aspects of the SI joint under fluoroscopic guidance and then entering the SI joint in the most caudal aspect. Objective: We wish to highlight that there is no added advantage to aligning both the anterior and posterior joint lines of the SI joint as it is time consuming, associated with additional radiation exposure, and may make the entry into the posterior SI joint technically more difficult. Study Design: Observational study. Setting: Pain Clinic, Department of Anesthesiology. Methods: With the patient lying prone on fluoroscopy table, SI joint injection is performed with a 22 G, 10 cm spinal needle in a true anteroposterior (AP) view, where anterior and posterior SI joint spaces are seen as separate entities, where the medial joint space represents the posterior SI joint and the lateral joint space represents the anterior SI joint. The distal 1 cm of the medial joint space is entered under AP view. If the SI joint is seen as a straight line rather than 2 joint spaces in the AP view then the image intensifier of the fluoroscope was tilted cranially to elongate the image of the lower part of the posterior SI joint, thus facilitating entry into this part of the joint which was confirmed by administering 0.3 to 0.5 mL of radiopaque contrast medium. Result: Sixty SI joints of 58 patients were injected under an AP fluoroscopic view. Forty-two (70%) SI joints were seen as 2 separate medial and lateral joint spaces and were entered in distal 1 cm of the medial joint space. In 18 (30%) joints seen as a straight line rather than 2 separate spaces, the image intensifier of the fluoroscope was tilted cranially to elongate the image of the lower part of the posterior SI joint and then the SI joint was entered in its distal 1 cm. Confirmation of entry into the SI joint was confirmed by with 0.3 to 0.5 mL of radiopaque contrast medium. In 4 cases the joints did not show the correct radiopaque contrast spread (3/42 and 1/18) although the needle seemed to be in the joint space. Limitations: Small sample size. Conclusion: Aligning the anterior and posterior aspects of SI joint for fluoroscopic guided SI joint injection is not necessary for the success of the block. Key words: Sacroiliac joint, injection, anteroposterior view, oblique angulation, fluoroscopic technique

No abstract

Introduction: Henochschonlein purpura (HSP) is an acute, systemic, immune complex-mediated, leukocytoclastic vasculitis, most commonly affecting children. It is a small-vessel vasculitis which is characterized by a tetrad of palpable purpura (without thrombocytopenia), abdominal pain, arthritis, and renal impairment. Although most commonly affecting the skin, joints, gastrointestinal tract, and kidneys, other organs may also be affected. Association of HSP with complex regional pain syndrome (CRPS) has not been reported in the literature. In the present case report, we are describing the successful management of CRPS of the upper limb in a diagnosed case of HSP. Case Presentation: A 14-year-old female patient, who was a diagnosed case of HSP, presented with features characteristic of CRPS in the right hand and forearm, based on the Budapest Diagnostic Criteria. Bone scintigraphy showed increased tracer uptake in joints of the right hand, also suggestive of CRPS. The pain was severe visual analog scale-90/100 and not controlled with conservative management. Patient was administered a series of 3 stellate ganglion minimally invasive pain and spine interventions (MIPSI) over the course of 2 weeks, which led to the resolution of her symptoms. Conclusion: HSP is a small-vessel vasculitis and may lead to peripheral nerve vasculitis. As reported in other cases, small-vessel vasculitis has led to the development of CRPS and thus may influence the development of CRPS in patients with HSP. CRPS as a complication of HSP has not been reported in the literature to date. Thus in a patient with HSP, CRPS could present as a rare complication and early intervention with the MIPSI of the affected region may lead to resolution of symptoms.