Sonographically Guided Costotransverse Joint Injections A Computed Tomographically Controlled Cacaveric Feasibility Study

Objectives-The primary purpose of this study was to describe and validate a novel sonographically guided costotransverse (CTRV) joint injection technique. Methods-The bilateral T3-T10 CTRV joints of an unembalmed cadaveric specimen were localized using a 12-3-MHz linear array transducer. A 22-gauge, 2.5-in spinal needle was directed into the CTRV joint using an in-plane, lateral-to-medial approach under direct sonographic guidance. After needle placement, 3-dimensional computed tomographic (CT) images were obtained to assess the locations of the needle tips. This step was followed by injection of an iodinated contrast agent and repeated CT to assess the contrast flow pattern. An experienced musculoskeletal radiologist reviewed the CT images and assessed the accuracy of the injections (intra- or extra-articular). For intra-articular injections, a quantitative assessment of the percentage of injectate within the joint was performed. Results-A total of 16 sonographically guided CTRV joint injections were completed on a single torso-pelvis specimen. Using our technique, 11 of 16 sonographically guided CTRV joint injections (68.8%) placed the contrast agent into the target joint. Quantitative analysis of the arthrograms showed 6 of 11 intra-articular injections (54.5%) with greater than 50% injectate within the joint capsule. Conclusions-To our knowledge, this study is the first to determine the feasibility of sonographically guided CTRV joint injections. Overall, 68.8% of injection attempts produced acceptable CTRV joint arthrograms, which compares favorably to a previously reported 76% accuracy rate for fluoroscopically guided CTRV joint injections. Although these injections are technically challenging, the use of sonographic guidance to perform CTRV joint injections is feasible and warrants further investigation to establish its role in the management of patients presenting with thoracic pain syndromes.