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Instability of the sternoclavicular joint is a rare diagnosis and will mostly be found after motor vehicle accidents or sports injuries. Depending on the severity of the trauma open reduction is rarely required, and most cases will be treated successfully with conservative management. Associated injuries to the surrounding anatomic structures are not rare, and can be found in posteriorly directed injuries.
The acromioclavicular and sternoclavicular joints have important soft-tissue static constraints that, based on biomechanical studies, imply a great deal of stability. The infrequency of significant symptoms following dislocations of these joints certainly highlights the fact that the dynamic muscle support is also very important. In performing resections of these joints for degenerative disease, our goal should be to preserve these important ligamentous supports by minimizing the amount of bone excised, as this seems to optimize results [84]. Precise isometric reconstruction of these complex, three-dimensional ligamentous structures merits further investigation in the laboratory and clinical settings.
The rarely occurring ankylosing hyperostosis of the sternoclavicular joints can be taken as a paradigm of chronic seronegative inflammation of tendinous insertion involving the capsular apparatus of the sternoclavicular joints. Etiologically uncertain erosions of the insertion lead to reparative ossifications. There are few symptoms but the course is protracted. If the condition cannot be arrested by anti-inflammatory drugs in its initial stages, there develops a progressive loss of sternoclavicular joint function. The case is described of a 66-year-old woman who has had the condition for 33 years. At wide intervals she has had severe pain. Electromyography a few years after biopsy gave an indication of mild irritation of the roots C 7 and C 8. Resulting from loss of function of the sternoclavicular joint the acromioclavicular joint was dislocated. No specific drug or surgical treatment has so far been necessary.
Bacterial arthritis of the sternoclavicular joint is an uncommon disorder caused by a variety of microorganisms. Both Gram-positive and Gram-negative bacteria have been identified as etiologies of an acute suppurative arthritis, whereas a few other bacteria such as mycobacteria and treponemes have been incriminated in chronic disease of the sternoclavicular joint. We recently treated a patient with staphylococcal synovitis of the sternoclavicular joint, which is the 24th recorded in the literature. His illness was complicated by a retrosternal abscess, soft tissue abscess of the chest, septic bursitis, and lumbosacral discitis. He recovered after 6 weeks of nafcillin therapy without any residual infection. Six previous patients with extension into the substernal space and mediastinum have been described. Staphylococcal infection of the sternoclavicular joint, although usually confined to the joint, can be associated with sepsis and metastatic abscess formation as well as substernal extension even in immunocompetent individuals.
Sternoclavicular dislocations are relatively infrequent, constituting less than 1% of somatic dislocations. Despite the fact that the sternoclavicular joint is the only articulation between the upper extremity and the axial skeleton, it possesses the least amount of osseous stability of any joint in the body. Sternoclavicular dislocations are generally divided into anterior and posterior disruptions, the former being the most common. An unusual case of an anterior dislocation of the sternoclavicular joint with a large superior component is described. It was found that coronal paraxial computed tomographic reconstruction of the joint was quite useful in evaluating this injury.
Posterior dislocation of the sternoclavicular joint is uncommon in children, difficult to diagnose, and may be confused with a physical injury of the medial clavicle. We reviewed our experience with posterior dislocations of the medial clavicle over a 10-year period, and found 5 children who had sustained this injury. The computed tomography (CT) scan was found to be the best diagnostic procedure to assess the integrity of the sternoclavicular joint. The cause of the dislocation was most commonly lateral compression of the shoulders sustained during contact sports, particularly football and hockey. Reduction was usually obtained by retraction of the shoulders; for persistent dislocations, a towel clip was used to lift the medial end of the clavicle into its reduced position with the patient under general anesthesia. Reduction was maintained with a figure-of-eight bandage. Any child presenting with pain and swelling in the region of the sternoclavicular joint and no evidence of obvious fracture of the clavicle should have the possibility of dislocation of the sternoclavicular joint investigated with a CT scan.
An acute monoarticular infection of the sternoclavicular joint due to coagulase-positive Staphylococcus aureus occurred without predisposing factors in a 48-year-old man. Pyogenic infection must be considered as a cause of pain and swelling of the sternoclavicular joint. Correctly diagnosed and promptly treated, the end results of sternoclavicular joint infection can be excellent.
Spontaneous sternoclavicular (SC) joint infections are uncommon. Most cases of contained SC joint infections respond well to conservative treatment measures such as intravenous antibiotics and local drainage. However, some cases are more extensive, extending beyond the boundaries of the joint capsule, occasionally involving the anterior chest wall and mediastinum. We report our experience with 3 patients with spontaneous advanced SC joint infections. Radical surgical treatment seemed to provide the best control of this infection.
Traumatic dislocation of the sternoclavicular joint is very uncommon (1,5% of all dislocation, 10% of all dislocations in clavicular joints; ratio acromioclavicular dislocations: sternoclavicular dislocations = 5-10:1). The functional importance of this joint requires open reduction with reconstruction of its ruptured ligaments and the disc. The sternoclavicular joint can be dislocated in association with congential, developmental, degenerative and inflammatory processes (M. Friedrich, rheumatoid arthritis). Epiphyseal separations or fractures of the medial end of the clavicle can usually be treated conservatively, but interposition of the joint capsule between the fragments may cause the dislocation to be irreducible. In addition to clinical examination and anteroposterior of oblique posteroanterior X-rays, tomography, computed tomography and arthrography can be of help in diagnosis. Additional special X-ray pictures as suggested by Heinig, Hobbs and Kattan are very helpful in determining the degree of dislocation (Allman). If open reduction is necessary, the functional importance of the disc and the angle of inclination of the joint socket must be taken into consideration.
X-rays of 102 sternoclavicular joints from post-mortem examination were interpreted systematically. In 89 cases we found an osteoarthrosis. We investigated the correlation between stage of osteoarthrosis and size and form of articular surface, age, sex and right or left preference. We also made a review about anatomy, embryology and pathology of the sternoclavicular joint. The differential diagnosis of sternoclavicular pain is discussed.
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OBJECTIVE: In trauma patients, gas (vacuum phenomenon) in the sternoclavicular joints could represent sequelae of significant distraction forces and thus serve as a potential marker for severe intrathoracic injury. We evaluated the significance and frequency of the finding of gas in the sternoclavicular joints on chest CT of patients with blunt trauma. SUBJECTS AND METHODS: We prospectively studied all chest CT examinations performed at our institution over a 14-week period for the finding of gas in the sternoclavicular joints. Chest CT examinations (n = 267) were performed in 234 patients. We excluded data from follow-up CT examinations (n = 33), limiting our evaluation to the initial CT examination for each patient. Of the study population, 103 patients (83 men and 20 women) who ranged in age from 14 to 79 years (mean, 40 years) had sustained blunt chest trauma. For all trauma patients, we recorded the mechanism of injury and the associated thoracic injuries. RESULTS: CT revealed gas in the sternoclavicular joints in 47 patients (21%). Gas was unilateral in 27 patients and bilateral in 20 patients. Sternoclavicular joint gas was seen in 39 (38%) of the 103 trauma patients but was found in only eight (6%) of the 131 nontrauma patients (p < .0001). In the 39 trauma patients with sternoclavicular joint gas, associated thoracic injuries were seen in 17 patients (44%); either a sternal fracture or a retrosternal hematoma was seen in three patients. Radiographically evident thoracic injury was revealed in 20 (31%) of the 64 trauma patients who had no gas in the sternoclavicular joint; however, 10 of these 20 patients had either a sternal fracture or a mediastinal hematoma. CONCLUSION: Although gas in the sternoclavicular joints is more frequently seen in patients with blunt chest trauma than in patients undergoing chest CT for other indications, this finding does not indicate a greater risk of significant mediastinal or thoracic injury.
Acute and chronic traumatic injuries of the sternoclavicular joint require accurate diagnosis and management if complications are to be avoided. Sternoclavicular subluxation or dislocation, medial clavicle physeal injuries, and degenerative arthritis are the most frequently diagnosed of these relatively uncommon injuries. The medial clavicular epiphysis does not ossify until the 18th to 20th year. Knowledge of its developmental anatomy is essential because most physeal injuries will heal with time without surgical intervention. In contrast, posterior dislocation of the sternoclavicular joint requires prompt closed or open reduction, as posterior displacement of the medial clavicle has been associated with numerous complications, including respiratory distress, venous congestion or arterial insufficiency, brachial plexus compression, and myocardial conduction abnormalities. A myriad of procedures have been recommended for repair or reconstruction of the sternoclavicular joint. On the basis of the authors' experience and review of the literature, they advocate surgical resection of the medial clavicle, with maintenance, repair, or reconstruction of the costoclavicular ligaments, when surgery is indicated. Metallic-pin fixation of the joint should be avoided, as Steinmann pins, Kirschner wires, threaded pins with bent ends, and Hagie pins have all been reported to migrate and cause serious complications, including death.
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Two cases of dislocation of the sternoclavicular joint are reported in which migrating nails caused fatal heart tamponade. In both cases death occurred due to fracture nails which had not been bent or secured against migration in some way, and X-ray control had been inadequate. The doctors were charged with manslaughter by negligence since they had not exercised reasonable care as would have been required in those circumstances. As a result of the two attending physicians, trials, it is concluded when that operative osteosynthesis techniques are applied in order to affix dislocations of the sternoclavicular joint, migration of the osteosynthesis material must be prevented by adequate measures and that X-rays have to be taken within short intervals from different planes. Osteosynthesis material should be removed as soon as possible.
A case of atraumatic, spontaneous, bilateral, sternoclavicular joint subluxation in a 20-year-old man on combat duty in Iraq is reported. There was no history of an underlying pathologic condition and no history of injury to the area. The patient demonstrated recurrent, mildly painful, subluxation whenever either arm was abducted past 80 degrees to 90 degrees. Computed tomographic scans of the joints in both reduction and subluxation were obtained, and pseudodislocation was excluded. The patient was reassured that the subluxation would not affect his upper extremity strength, was treated with conservative measures, and returned to duty. The literature was reviewed for comparison of surgical and nonsurgical options. Surgical stabilization of sternoclavicular joint dislocations is associated with a high incidence of serious complications. Spontaneous sternoclavicular joint subluxations have a benign course and do not fare well after surgical repair. It is recommended that all grade I and II sternoclavicular joint sprains be treated conservatively.
We describe a case of septic arthritis of the sternoclavicular joint caused by Fusobacterium in an otherwise healthy young man. The Fusobacterium had morphologic features most in keeping with Fusobacterium (F.) necrophorum, which was a common organism in sternoclavicular septic arthritis in the preantibiotic era. To our knowledge this is the first reported case of a fusobacterium sternoclavicular joint infection in the antibiotic era. This case should lead to heightened awareness of sternoclavicular joint infection and fusobacterium joint infection in the healthy host.
PURPOSE: To correlate magnetic resonance (MR) images of the sternoclavicular joint with anatomic sections. MATERIALS AND METHODS: MR imaging was performed on 14 sternoclavicular joints in seven specimens from cadavers (three men and four women 64-94 years of age at death; mean, 84 years). MR arthrography was performed in four specimens (eight joints), after injection of gadopentetate dimeglumine. After imaging, the specimens were frozen and cut into 3-mm-thick slices along the MR imaging planes. Images were correlated with the anatomic slices. RESULTS: MR imaging depicted the anatomy of the sternoclavicular joint and surrounding soft tissue. T2-weighted and proton-density-weighted images were superior to T1-weighted images in depiction of the intraarticular disk. MR arthrography depicted best the intraarticular disk and four of five perforations and delineated the joint capsule. All perforations also were depicted on T2-weighted images. CONCLUSION: MR imaging allows delineation of all structures of the sternoclavicular joint. MR arthrography allows delineation of perforations of the intraarticular disk.