This document discusses the sacroiliac joint and use of prolotherapy for healing joint capsules beyond just the SI joint. It provides background on the author's medical training and experience with prolotherapy. It describes how prolotherapy is performed under fluoroscopic guidance using dextrose or similar solutions to strengthen ligaments and joint capsules. The importance of treating the joint capsule is discussed, noting that an intact capsule is needed to prevent pain from fluid leakage and maintain nourishment of cartilage. Case studies of successful prolotherapy treatments for the shoulder, ankle, toe, and hip are briefly presented.

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?