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Thoracic costotransverse joint pain patterns: a study in normal volunteers.

Young BA, Gill HE, Wainner RS, Flynn TW - BMC Musculoskelet Disord (2008)

Bottom Line: Average pain produced was 3.3/10 on a 0-10 verbal pain scale.This study provides preliminary data of the pain referral patterns of costotransverse joints.Further research is needed to compare these findings with those elicited from symptomatic subjects.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Physical Therapy, Sheppard Air Force Base, Texas, USA. byoungpt@earthlink.net

ABSTRACT

Background: Pain referral patterns of asymptomatic costotransverse joints have not been established. The objective of this study was to determine the pain referral patterns of asymptomatic costotransverse joints via provocative intra-articular injection.

Methods: Eight asymptomatic male volunteers received a combined total of 21 intra-articular costotransverse joint injections. Fluoroscopic imaging was used to identify and isolate each costotransverse joint and guide placement of a 25 gauge, 2.5 inch spinal needle into the costotransverse joint. Following contrast medium injection, the quality, intensity, and distribution of the resultant pain produced were recorded.

Results: Of the 21 costotransverse joint injections, 16 (76%) were classified as being intra-articular via arthrograms taken at the time of injection, and 14 of these injections produced a pain sensation distinctly different from that of needle placement. Average pain produced was 3.3/10 on a 0-10 verbal pain scale. Pain was described generally as a deep, dull ache, and pressure sensation. Pain patterns were located superficial to the injected joint, with only the right T2 injections showing referred pain 2 segments cranially and caudally. No chest wall, upper extremity or pseudovisceral pains were reported.

Conclusion: This study provides preliminary data of the pain referral patterns of costotransverse joints. Further research is needed to compare these findings with those elicited from symptomatic subjects.

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Image of poor injection, left T5.
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Figure 3: Image of poor injection, left T5.

Mentions: No complications occurred in any subject from participation in this study. The mean radiation exposure time was 4.85 ± 1.03 minutes. Out of 24 potential costotransverse joint injections, a total of 21 injections were completed. The breakdown of the number of injections by joint and their classification, along with reasons for unperformed injections, are depicted in Table 1. Six arthrograms from the 21 completed costotransverse joint injections (29%) were classified as good, and 10 (47%) were classified as equivocal. Extracapsular spread of the injected medium was one reason to terminate further injection into the joint. As there were no differences in the pain pattern reported for those joints rated as good and equivocal, and there was evidence of intracapsular injection prior to the extracapsular spread, the good and equivocal groups were therefore combined into a "successful" injections category for the remainder of the analysis. The remaining 5 (24%) joint arthrograms were classified as poor, giving our accuracy of needle placement into the costotransverse joint utilizing fluoroscopy as 76%. Examples of each classification are presented in figures 1, 2, 3.


Thoracic costotransverse joint pain patterns: a study in normal volunteers.

Young BA, Gill HE, Wainner RS, Flynn TW - BMC Musculoskelet Disord (2008)

Image of poor injection, left T5.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2587465&req=5

Figure 3: Image of poor injection, left T5.
Mentions: No complications occurred in any subject from participation in this study. The mean radiation exposure time was 4.85 ± 1.03 minutes. Out of 24 potential costotransverse joint injections, a total of 21 injections were completed. The breakdown of the number of injections by joint and their classification, along with reasons for unperformed injections, are depicted in Table 1. Six arthrograms from the 21 completed costotransverse joint injections (29%) were classified as good, and 10 (47%) were classified as equivocal. Extracapsular spread of the injected medium was one reason to terminate further injection into the joint. As there were no differences in the pain pattern reported for those joints rated as good and equivocal, and there was evidence of intracapsular injection prior to the extracapsular spread, the good and equivocal groups were therefore combined into a "successful" injections category for the remainder of the analysis. The remaining 5 (24%) joint arthrograms were classified as poor, giving our accuracy of needle placement into the costotransverse joint utilizing fluoroscopy as 76%. Examples of each classification are presented in figures 1, 2, 3.

Bottom Line: Average pain produced was 3.3/10 on a 0-10 verbal pain scale.This study provides preliminary data of the pain referral patterns of costotransverse joints.Further research is needed to compare these findings with those elicited from symptomatic subjects.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Physical Therapy, Sheppard Air Force Base, Texas, USA. byoungpt@earthlink.net

ABSTRACT

Background: Pain referral patterns of asymptomatic costotransverse joints have not been established. The objective of this study was to determine the pain referral patterns of asymptomatic costotransverse joints via provocative intra-articular injection.

Methods: Eight asymptomatic male volunteers received a combined total of 21 intra-articular costotransverse joint injections. Fluoroscopic imaging was used to identify and isolate each costotransverse joint and guide placement of a 25 gauge, 2.5 inch spinal needle into the costotransverse joint. Following contrast medium injection, the quality, intensity, and distribution of the resultant pain produced were recorded.

Results: Of the 21 costotransverse joint injections, 16 (76%) were classified as being intra-articular via arthrograms taken at the time of injection, and 14 of these injections produced a pain sensation distinctly different from that of needle placement. Average pain produced was 3.3/10 on a 0-10 verbal pain scale. Pain was described generally as a deep, dull ache, and pressure sensation. Pain patterns were located superficial to the injected joint, with only the right T2 injections showing referred pain 2 segments cranially and caudally. No chest wall, upper extremity or pseudovisceral pains were reported.

Conclusion: This study provides preliminary data of the pain referral patterns of costotransverse joints. Further research is needed to compare these findings with those elicited from symptomatic subjects.

Show MeSH
Related in: MedlinePlus