Technique of Injection

The patient lies supine with the symptomatic joint at the operator side. The skin is punctured about 5 mm above the middle of the cartilaginous surface of the manubrium. The needle is inserted according to a descending route toward the inferior border of the proximal end of the clavicle (Fig. 8). A lower site of skin puncture would lead the needle to enter the meniscus or the cartilage of the first rib. Opacification first occurs in the subclavicular synovial recess. The joint cavity has a crescent shape with a thin interosseous part and a thick subclavicular part corresponding to the synovial recess (Fig. 9). Small synovial diverticles may be present at the superior part of the joint (Fig. 10).

FIGURE 8 Needle placement into a sternoclavicular joint.

FIGURE 9 Subclavicular synovial recess (arrows) in an opacified sternoclavicular joint.

FIGURE 10 Small synovial recess diverticles (arrowheads) in a degenerative sternoclavicular joint with enlarged subclavicular synovial recess (star).

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Dealing With Back Pain

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