REVIEWThe sternocostoclavicular joint: normal and abnormal features
Section snippets
Anatomy and physiology of the sternocostoclavicular joint
The sternoclavicular joint is a diarthrosis between the medial end of the clavicle and a notch in the superolateral portion of the manubrium sterni (figure 1A). A projection extending downward from the manubrial notch receives the upper edge of the first costal cartilage, so that the joint is actually sternocostoclavicular rather than only sternoclavicular. The articular surfaces on the manubrium and clavicle are saddle-shaped, with the concave manubrial surface fitting over the convex
Investigating the sternocostoclavicular joint
A variable combination of pain and swelling occurs in most SCCJ disorders. The pain often draws attention immediately to the SCCJ, although in some cases it predominates in the scapulohumeral area. Pressure on the SCCJ usually replicates the spontaneous pain. The swelling is readily detected by comparing the joint with the other side. Local inflammatory changes, if present, should focus attention on the possibility of septic arthritis. Details of the patient’s medical history should be
Computed tomography features of the normal sternocostoclavicular joint
Few studies on the normal SCCJ are available. Most focused on the sternum 2, 3, 6. Hatfield et al. retrospectively studied 350 patients admitted for a variety of conditions, none of which were known to involve the anterior chest wall. The age range was 9 days to 94 years. SCCJ space width, intraarticular vacuum phenomenon, and chondrocostal ossification or calcification were the only parameters studied. Joint space width was wider in males than in females and was not influenced by age. An
Normal images that can be misleading
In subjects aged 15 to 25 years, persistence of the medial clavicular apophysis is seen as a slender linear structure that can be mistaken for a calcification or a fracture (figure 4) 〚4〛. Congenital absence of this apophyseal ossification center produces a cupped or fork-like appearance. Supernumerary ossicles are seen in about 1.5% of unselected individuals, usually above and posterior to the manubrium (figure 5). They should be distinguished from bony fragments detached by a fracture and
Degenerative disease of the SCCJ
Degenerative disease is probably the most frequent disorder of the SCCJ. Asymptomatic forms are common and the diagnosis is often overlooked. Autopsy studies have shown that degenerative SCCJ disease is present in virtually all subjects older than 50 years 〚8〛. The rate of occurrence of clinically significant disease is difficult to determine because the symptoms are usually mild and are not looked for routinely. The lesions are considerably more severe on the dominant side. Mechanical pain is
Arthritis of the sternocostoclavicular joint
Early diagnosis of septic arthritis is vital 11, 12 to prevent potentially severe infectious complications. Development of arthritis of the SCCJ can help in the nosological classification of some joint diseases.
Septic arthritis should be considered routinely when no other joints are involved. A combination of fever, mechanical pain, and mild erythrocyte sedimentation rate elevation is common and misleading. Septic arthritis of the SCCJ accounts for only about 2% of all cases of septic
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Cited by (15)
Arthropathies of the anterior chest wall. Radiographic features
2015, Revue du Rhumatisme MonographiesMultidetector computed tomography findings of the sternoclavicular joint in patients with rheumatoid arthritis
2013, Clinical ImagingCitation Excerpt :Symptomatic involvement of the sternoclavicular joint (SCJ) has been reported in 1–41% of patients with RA [4,5] in a limited number of studies. In RA, because of the clinical severity of other joint involvements, the SCJ is often underestimated [10,11]. Abovementioned studies were performed by direct roentgenography and clinical assessment, whereas radiographic assessment of this joint is usually diffucult due to superposition.
Mediastinal mass: A diagnostic conundrum
2007, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :Some authors have reported that it may account for as many as 9% of cases.3 The SCJ involvement is associated with diabetes, systemic steroid therapy, alcoholism, intravenous heroin abuse, immunoparesis, rheumatoid arthritis, and local infection and can occur as a rare complication of subclavian vein thrombosis.2,4 It has also been reported in healthy or apparently healthy individuals.4
Septic sternoclavicular arthritis
2006, Revue du Rhumatisme (Edition Francaise)Operative treatment of the painful sternoclavicular joint: A new technique using interpositional arthroplasty
2006, Journal of Shoulder and Elbow SurgeryShoulder injections for osteoarthritis and other disorders
2004, Physical Medicine and Rehabilitation Clinics of North America