1. HEALING THE CAPSULE:
THE SACROILIAC JOINT AND
BEYOND
Alfred H Grimes, MD
Pinnacle Pain Medicine
550 W Washington St #2
Carson City, NV 89703
775-841-7246

2. MY BACKGROUND
• BOARD CERTIFIED IN
ANESTHESIOLOGY-1984
• PM&R RESIDENCY AT BAYLOR-BC IN 2001
• PAIN FELLOWSHIP AT UCSF-SUBSPEC
CERT IN 2001
• AAOM-PROLO SINCE 2000

3. HOW WE DO PROLO
History-Physical Exam
Diagnostic then Therapeutic Injections
P2G +/- SM
DILUTED WITH CARBOCAINE/MARCAINE
FLUOROSCOPIC GUIDANCE

4. WHY FLUOROSCOPY?
• 1. INCREASED ACCURACY OF NEEDLE
PLACEMENT. ESPECIALLY IN OBESE PATIENTS.
• 2. ARTHROGRAMS SHOW INITIAL DAMAGE AS
WELL AS SUBSEQUENT HEALING OF DAMAGED
CAPSULES AND LIGAMENTS!
• A PICTURE IS WORTH A THOUSAND WORDS!

5. • CAPSULAR TEARS CORRESPOND TO
PAINFUL AREAS
• ARTHROGRAMS CAN LET YOU KNOW
WHEN TREATMENT IS COMPLETE
• THEY ARE HELPFUL IN CONVINCING
PATIENTS OF THE NEED FOR FURTHER
TREATMENT DESPITE BEING PAIN FREE

6. WHY IS TREATING THE CAPSULE
IMPORTANT ?
• CAPSULE IS RICHLY INNERVATED, THEREFORE ANY
STRETCHING OF CAPSULE OR INCOMPETENTENCY
WILL CAUSE PAIN.
• CAPSULE SHOULD BE INTACT TO PREVENT
EXTRAVASATION OF JOINT FLUID
• JOINT FLUID NOURISHES CARTILAGE
• LACK OF JOINT FLUID LEADS TO IMPINGEMENT, PAIN,
AND DEATH OF CARTILAGE.
• CAPSULE INTEGRITY A MUST.
• ONLY WITH ARTHROGRAMS CAN BE SURE HEALING IS
COMPLETE.

7. Gabrielle F
• 44 y/o F
• Complaint was abdominal (Low Pelvic)
pain
• GI/Surgical w/u nondiagnostic
• Diagnostic SIJ injections eliminated pain
for 24 hours.

10. ROBERT G
• 42 y/o male injured shoulder while
working on automobile
• Presented with classic impingement signs

14. REINJURY

17. JAMES N
• 63 y/o male injured shoulder while skiing,
weight lifting
• Classic impingement

22. GREGORY R
• 45 y/o male with injury secondary to
rugby, skiing
• Classic impingement

23. L Shoulder

28. R Shoulder

33. Shannon R
• 33 y/o triathelte with L ankle pain, h/o
twisting ankle multiple times
• Failed cortisone, refused ankle fusion

37. Patrick P
• 50 y/o M
• R toe pain, s/p fusion

42. R HIP PROLO
• 76 Y/O Female with R hip pain s/p R SIJ
prolo

45. QUESTIONS?