Ultrasound-Guided Injection Technique for Manubriosternal Joint Pain



Ultrasound-Guided Injection Technique for Manubriosternal Joint Pain





CLINICAL PERSPECTIVES

The manubriosternal joint is susceptible to injury from acute blunt trauma from motor vehicle accidents and contact sports such as football and rugby as well as repetitive microtrauma from chronic coughing and activities that require active protraction and retraction of the shoulders. Left untreated, the acute inflammation associated with the injury may result in arthritis with its associated pain and functional disability.

Patients suffering from manubriosternal joint dysfunction or inflammation will complain of a marked exacerbation of pain when they perform activities that require thrusting the arm forward and retracting or shrugging the shoulder and with deep inspiration. A clicking sensation with joint movement is often noted, and the patient frequently is unable to sleep on the abdomen or side. Patients with manubriosternal joint dysfunction and inflammation will exhibit pain on active protraction or retraction of the shoulder as well as with raising of the arm high above the head. Palpation of the manubriosternal joint often reveals swelling or enlargement of the joint secondary to joint inflammation. If there is disruption of the joint, it may sublux or dislocate, and joint instability and a cosmetic defect may be evident on physical examination.






FIGURE 84.1. Plain radiograph of patient who sustained blunt chest wall trauma. A: Arrows indicated a widened mediastinum. B: Lateral radiograph reveals complete posterior dislocation of the body of the sternum at the manubriosternal joint. Note the anterior chest wall soft tissue swelling. (Reused from Pope TL, Harris JH Jr. Harris & Harris’ The Radiology of Emergency Medicine. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013:505, with permission.)

Plain radiographs are indicated in patients suffering from manubriosternal joint pain. They may reveal psoriatic arthritis, ankylosing spondylitis, Reiter syndrome, or widening of the joint consistent with joint injury (Fig. 84.1). They may also reveal occult fractures or primary or metastatic tumors of the joint as the joint is susceptible to invasion by tumors of the mediastinum including thymoma. If joint instability, infection, or tumor is suspected or detected on physical examination, magnetic resonance imaging, computerized tomography, and/or ultrasound scanning is a reasonable next step (Fig. 84.2). Ultrasound-guided manubriosternal joint injection can aid the clinician in both the diagnosis and treatment of manubriosternal joint pain and dysfunction.







FIGURE 84.2. CT of infectious arthritis. A 31-year-old IV drug abuser presented with anterior chest pain and fever. Lateral radiograph of the chest shows a large soft tissue swelling anteriorly to the upper sternum (arrows). (Greenspan A, Gershwin ME. Imaging in Rheumatology. Philadelphia: Wolters Kluwer; 2018.)






FIGURE 84.3. Anatomy of the manubriosternal joint. (Waldman SD. Waldmans Comprehensive Atlas of Diagnostic Ultrasound of Painful Conditions. Philadelphia: Wolters Kluwer; 2016.)

Mar 1, 2020 | Posted by in ANESTHESIA | Comments Off on Ultrasound-Guided Injection Technique for Manubriosternal Joint Pain
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