title: CT-guided sternoclavicular joint injections: description of the procedure, reliability of imaging diagnosis, and short-term patient responses.
abstract: OBJECTIVE
  The purpose of this study was to evaluate pain relief 20 to 30 minutes after diagnostic or therapeutic injections into the sternoclavicular joint and to compare patient outcomes based on the CT diagnosis.
  
  
  METHODS
  Informed consent was obtained from each patient. Ethics approval was not required. Fifty patients who had CT-guided injections of corticosteroid and local anesthetic into their sternoclavicular joints were included in the study. Preinjection and 20- to 30-minute postinjection visual analog scale data were recorded and compared with the imaging findings agreed by consensus. Kappa statistics were calculated for the reliability of imaging diagnosis. The percentage of patients improving after joint injection was calculated, and the risk ratio comparing the response of patients with osteoarthritis to those without osteoarthritis was completed. The correlation between the severity of each patient's osteoarthritis and the pain response was calculated using Spearman's correlation coefficient.
  
  
  RESULTS
  Sixty-six percent of the patients reported clinically significant pain reduction at between 20 and 30 minutes after injection. The proportion of patients with osteoarthritis who had a clinically significant response was 67% compared with 64% for patients who did not have osteoarthritis. This difference was not statistically or clinically significant. There was no correlation between the severity of osteoarthritis and the amount of pain reduction (r = 0.03). The reliability of imaging diagnosis was substantial.
  
  
  CONCLUSIONS
  Two thirds of patients having sternoclavicular joint injections of corticosteroids and local anesthetics report clinically significant improvement regardless of the abnormalities detected on their CT images.
authors.affiliation: Department of Radiology, Orthopaedic University Hospital of Balgrist, Forchstrasse 340, 8008 Zürich, Switzerland. cynthia.peterson@balgrist.ch
authors.forename: Cynthia K
authors.initials: CK
authors.lastname: Peterson
authors.forename: Nadja
authors.initials: N
authors.lastname: Saupe
authors.forename: Florian
authors.initials: F
authors.lastname: Buck
authors.forename: Christian W A
authors.initials: CW
authors.lastname: Pfirrmann
authors.forename: Marco
authors.initials: M
authors.lastname: Zanetti
authors.forename: Juerg
authors.initials: J
authors.lastname: Hodler
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D007479:Iopamidol / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D010147:Pain Measurement; D015641:Radiography, Interventional / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013247:Sternoclavicular Joint / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000779:Anesthetics, Local; D003287:Contrast Media; D007479:Iopamidol