Sacro Iliac Injection!

The ultrasound image above is centered over the cranial edge of the pelvic rim. The red line corresponds to the pelvic rim and the green line corresponds to the transverse process of the last lumbar vertebrae.

The picture above shows the "cranial" approach with a long spinal needle for treatment of the sacro-iliac joint (SI). From the exterior of the horse it is very difficult to visualize the SI joint however proper alignment of the spinal needle via ultrasound guidance will result in accurate treatment of the SI joint space. The needle is inserted in front of the pelvis and guided just below the rim of the pelvis (see pic below)

This technique requires ultrasound guidance of a skilled operator. The typical complaint from the rider/trainers include poor performance, no obvious lameness, unwilling to maintain a particular lead, cross-cantering, and painful response to deep pressure over the gluteous musculature. The Sacro iliac joint can be visualized per rectum and may also be evaluated via nuclear scintigraphy. The response to treatment usually requires 10-14 days before a clinical improvement is noted and it can be very significant. The most interesting aspect of SI inflammation is that these horses are rarely lame however their performance as diminished!

The above ultrasound view is per rectum and shows the SI joint. In this case, there are bony changes around the joint which are consistent with arthritis.