Fluoroscopically guided scapulothoracic injections.

Abstract

After informed consent was obtained from the patient, the patient was placed in a prone oblique position on the fluoroscopy table of a C -arm system (Angioskop D 33, Siemens Medical Systems, Erlangen, Germany). The patient was asked to place the arm of the painful side either above the head or at the side of the body to move the scapula away from the chest wall. The choice of arm position depended on which one was more comfortable for the patient and which one best opened the tender area between the scapula and the ribs. The C -arm was rotated until the scapula and the scapulothoracic space were seen in profile. In most patients, the fluoroscopy tube was angled cephalocaudally to profile the anterior and posterior portions of the rib of interest in the same plane, which produced a lordotic view of the ribs. This view helped prevent inadvertent needle puncture of the rib interspace. The patient was asked where the pain was centered while the radiologist palpated medial and deep in relation to the scapula. The site of maximal tenderness was chosen for the