Costochondral junction injection can be very useful as a diagnostic or therapeutic procedure in patients with costochondritis and Tietze’s syndrome.
After informed consent is obtained, the patient is positioned in the supine position. The involved costochondral joints are palpated for local tenderness and replication of pain complaint. The patient is prepared in a standard aseptic fashion over an area large enough to allow palpation of landmarks, and sterile technique is used throughout the procedure. A 1-in. (2.5-cm), 25-gauge needle is inserted at the point of maximum tenderness to the level of costochondral cartilage and withdrawn 1 mm. After negative aspiration, a 2-mL mixture of 40 mg of methylprednisolone acetate or equivalent and local anesthetic is injected into each involved costochondral junction.
It is not necessary to advance the needle into the costochondral joint. Infiltration of the superficial tissue over the interosseous groove of the joint at the point of maximal tenderness is usually adequate. Tenderness with costochondritis is often present over more than a single costochondral joint. Tenderness and swelling of a single costochondral joint is found with Tietze’s syndrome. The presence of chest wall pain does not exclude underlying heart or lung disease. Similar injection techniques are used for the costoclavicular junction (Fig. 67-35).
FIGURE 67-35. Costochondral and costoclavicular junction injection. Approach for costochondral and costoclavicular junction aspiration and injection. (From Steinbrocker O, Neustadt DH. Aspiration and Injection Therapy in Arthritis and Musculoskeletal Disorders. Hagerstown, MD: Harper & Row; 1972:42, with permission.)
Serious complications are uncommon with appropriate needle placement. Pneumothorax is possible with inadvertent penetration of the thorax. Most pneumothoraces can be easily treated with administration of supplemental oxygen and close observation and, when necessary, needle aspiration of air. Only those pneumothoraces that result in significant dyspnea or those under tension require chest tube thoracotomy and vacuum drainage.