title: Effectiveness of intra-articular steroid injection for atlanto-occipital joint pain.
abstract: OBJECTIVE
  The aims of this study were to evaluate the role of intra-articular joint injection for atlanto-occipital (AO) joint pain and to determine pain referral sites from that joint.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  We evaluated 29 patients with chronic refractory neck pain and/or headache, and limited range of lateral bending with rotation at the AO joint on physical examination. Of the 24 patients who consented to undergo diagnostic injections, 20 patients had at least 50% relief from pain and underwent two AO intra-articular injections of mixture of local anesthetic and steroid approximately 1 week apart. Patients completed pain drawings, visual analog scales (VASs) for pain, and neck disability index (NDI) for level of function. Patients were evaluated for 2 months after the first injection.
  
  
  RESULTS
  There was headache in 14/20 (70%), posterior neck pain (PNP) in 20, and referred pain in 17 (85%). The average VAS values for headache, PNP, and other referred pains were reduced significantly from 5.64, 5.70, and 5.41, respectively, before treatments to 0.64, 2.30, and 1.71, respectively, two months after injection (P < 0.01). The average NDI value was reduced significantly from 39.95% at pretreatment to 20.40% at 2 months after treatment (P < 0.01).
  
  
  CONCLUSIONS
  AO intra-articular steroid injection appears effective for the short-term control of chronic refractory pain arising from the AO joint.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea.
authors.forename: Dong-Gyu
authors.initials: DG
authors.lastname: Lee
authors.affiliation: Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, South Korea.
authors.forename: Yun-Woo
authors.initials: YW
authors.lastname: Cho
authors.affiliation: Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, South Korea.
authors.forename: Sung-Ho
authors.initials: SH
authors.lastname: Jang
authors.affiliation: Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, South Korea.
authors.forename: Su-Min
authors.initials: SM
authors.lastname: Son
authors.affiliation: Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, South Korea.
authors.forename: Gook-Joo
authors.initials: GJ
authors.lastname: Kim
authors.affiliation: Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, South Korea.
authors.forename: Sang-Ho
authors.initials: SH
authors.lastname: Ahn
mesh_terms: D000328:Adult; D000368:Aged; D018771:Arthralgia / Q000000981:diagnostic imaging / Q000188:drug therapy*; D001269:Atlanto-Occipital Joint / Q000000981:diagnostic imaging / Q000187:drug effects*; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000187:drug effects* / Q000379:methods; D011446:Prospective Studies; D011859:Radiography; D016896:Treatment Outcome; D014221:Triamcinolone / Q000008:administration & dosage*
chemical_list: D005938:Glucocorticoids; D014221:Triamcinolone
keywords: Atlanto-Occipital Joint; Cervicogenic Headache; Headache; Intra-Articular Injection