Pain Management Procedures
Sternocostal and Chest-Wall Joint Injections
Sternocostal and Chest-Wall Joint Injections
What are they?
The ribs connect to cartilage and then to the breastbone through small joints and tissue attachments. Inflammation or arthritis in these structures can cause very focused pain at the front of the chest. A sternocostal or related chest-wall injection places local anesthetic and sometimes corticosteroid at the suspected painful joint or attachment.
When may it be recommended?
The procedure may be considered only after a clinician determines that the symptoms are musculoskeletal and localizable. Heart, lung, blood-vessel, esophageal, and other causes of chest pain must be considered first. Reproducible tenderness at one joint and pain with movement or deep breathing may support a chest-wall source.
What happens?
You lie on your back. Ultrasound is commonly useful because the target can be close to the lung, internal thoracic blood vessels, and heart. The skin is cleaned and numbed, and a small needle is guided into or beside the painful joint before medication is injected.
What should I expect?
Temporary localized numbness or pressure is common. A clear but short response to anesthetic can help confirm the diagnosis. Any steroid benefit generally develops over several days. Activity that repeatedly irritates the area may need to be modified.
Important risks
Risks include bleeding, infection, medication reaction, temporary pain flare, injury to cartilage, and uncommon puncture of the pleura or nearby blood vessel. New shortness of breath or severe chest pain after the procedure requires emergency evaluation.
Preparing for your injection procedure…
Your instructions will depend on the procedure. Before any injection, tell the APG team if you:
Take aspirin, warfarin, clopidogrel, apixaban, rivaroxaban, or another medicine or supplement that affects bleeding. Never stop a prescribed blood thinner unless the clinician who manages it and the procedure team tell you how to do so safely.
Have diabetes, glaucoma, a bleeding disorder, an active infection, fever, or recent antibiotic treatment.
Could be pregnant, have an allergy to contrast dye or local anesthetic, or have reacted to steroid injections before.
Use an implanted pacemaker, defibrillator, spinal cord stimulator, or other electrical device.
Some procedures require fasting, a medication adjustment, or a responsible adult to drive you home, especially when sedation is planned. Follow the instructions provided for your specific appointment.
After your injection procedure…
Most injections are outpatient procedures. Mild soreness, bruising, temporary numbness, or a brief increase in the usual pain can occur. Follow the activity and bandage instructions you receive. Steroid medicine may take several days to have an effect and can temporarily raise blood sugar.
Call the office promptly for increasing redness, drainage, fever, severe or rapidly worsening pain, or new numbness or weakness. Seek emergency care for trouble breathing, chest pain, sudden loss of bladder or bowel control, a severe new headache, loss of vision, stroke-like symptoms, or rapidly progressing weakness.
This information is for general education and does not replace medical advice, diagnosis, or treatment. Not every procedure is appropriate for every patient, and results vary. Your APG care team will review your symptoms, examination, imaging, medical history, medications, and prior treatment before recommending a plan. Coverage requirements also vary by insurance plan.