We propose that near-nerve needle recording is a simple technique to employ for clinicians with experience in ultrasound-guided needle placement, especially when evaluation is critical and responses are difficult to obtain. However, given the degree of side-to-side variability in healthy subjects, we recommend caution when interpreting side-to-side differences.
A Computed Tomographically Controlled Cadaveric Feasibility Studyack pain is a common problem with a lifetime prevalence of approximately 80%. [1][2][3] Although thoracic back pain accounts for only 15% to 20% of all back pain syndromes, the disability incurred by patients with thoracic back pain is equal to that experienced by those with cervical or lumbar spinal pain. [3][4][5] Among symptomatic patients presenting with thoracic pain, multiple potential pain generators have been identified, including but not limited to the thoracic facet joints, costovertebral joints, costotransverse (CTRV) joints, and thoracic intervertebral disks. [5][6][7] Given the high degree of structural integrity of the thoracic spine, there are multiple bony articulations, muscle layers, and ligamentous structures that experience substantial biomechanical stress during daily life. 8,9 The close proximity of these structures and variable 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 intraarticular 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.
This review article discusses the current role of ultrasound in the modern physiatric practice, both as a complementary diagnostic tool and as a modality for intervention guidance. Indications, limitations, techniques, guidelines for utilization, new training and credentialing initiatives, and potential for future research are discussed.
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