Detaillierte Beitrags-Information
| Beitragstitel | Sternoclavicular steroid injections and their role in decision-making for surgery |
|---|---|
| Beitragscode | P017 |
| Autoren | |
| Präsentationsform | Poster |
| Themengebiete |
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| Abstract |
INTRODUCTION: Sternoclavicular joint (SCJ) injections are standard first-line treatment for painful non-infectious pathologies of the SCJ after failed conservative treatment. Short-term effectiveness of corticosteroid injections of SCJ has been proven and therefore clinical use is well justified. However, long-term effects and the role of SCJ injections in decision-making for surgery are not yet sufficiently elaborated. METHODS: All patients, who received CT-guided SC steroid injection between January 2012 and January 2017 were retrospectively analyzed. Pain response immediately after SCJ injection was routinely prospectively documented in our clinical database. Furthermore questionnaires, including ASES-Score were sent to the patients. 34 patients with 49 SCJ injections replied the questionnaire (89%) with a median follow-up of 50 months after first SCJ Injection. 10 patients underwent subsequent surgery. Spearmen-Test was performed to investigate the Influence of short-term effect on outcome after surgery. The effect of SCJ injection on subgroups was compared with Mann-Whitney analysis. Pain on the VAS is depicted as mean±SD. RESULTS: Directly after SCJ injection, pain decreased from VAS 5.1±2.4 to VAS 3.5±3 (p < 0.001). When comparing effectiveness of SCJ injections for instability (VAS 6.3±2.1 to VAS 5.1±3.1, p=0.09, n=9) and for degenerative joint disease (VAS 5.1±2.4 to VAS 3.5±3 p < 0.001, n=38), the effect was less in patients with an unstable SCJ. When analyzing patients with multiple injections, pain reduction seemed to decrease in efficiency with repetition even tough statistical significance was not reached. The final ASES-Score was much lower, and therefore outcome was worse, in patients with multiple injections than in those who were satisfied after the first injection (p=0.01). In the 7 patients who underwent surgery for degenerative changes there was a very strong correlation of pain relief after last infiltration to the definitive outcome (ASES-Score at final follow-up) r=0.86, p=0.012. CONCLUSIONS: Sternoclavicular injections are a very useful tool in the context of degenerative sternoclavicular joint disorders; interestingly however, if local injections are repeated, there is a decreasing effect with subsequent SCJ injections. The amount of pain reduction after the last is, in case the affect is not long lasting, at least a strong indicator for the future success of an operative treatment of the sternoclavicular joint. |