[RADIOGRAPHIC STUDY OF THE MECHANICS OF THE STERNO-CHONDRO-CLAVICULAR JOINT (CENTER, AMPLITUDE AND RESTRAINT OF MOVEMENTS)].
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Tomography has definite proven value as a technique in studying objects obscured by overlying shadows. It is an adjunct study to conventional radiographs when the necessary detail for diagnosis is lacking in the routine examination. Particularly in skeletal tumors, tomography can be helpful in disclosing lesions too small to be noticed in the routine radiograph or resolve details in question in the conventional film that are pertinent to the diagnosis. This technique has also been of great benefit in detailing the anatomic structures of the spine, temporomandibular joints and sternoclavicular articulations. It has been of particular value in the evaluation of fracture-healing or the presence of pseudarthrosis and arthritis affecting the larger joints of the body.
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Twenty-six patients with suspected or known septic joints who had been studied by computed tomography were retrospectively reviewed. Eighteen patients (20 joints) proved to have septic arthritis. Computed tomography was advantageous in patients with acute septic arthritis of deep-seated axial joints, such as the hip and sacroiliac, where it demonstrated particular soft tissue swelling as early as 36 hours after the onset of symptoms. In three patients, this finding on computed tomography was helpful in accurately localizing the disease process and facilitating a diagnostic closed needle aspiration biopsy procedure. Four patients had a primary osseous focus of infection in an adjacent epiphyseal region that was documented by computed tomography. Computed tomography was superior to conventional radiology in revealing early articular bone erosion in joints with curved and overlapping articular surfaces in five patients, and resulted in alteration of their treatment. Fat-fluid levels within the suprapatellar bursae were noted in one patient (two joints). Computed tomography is a valuable modality for evaluation of patients with suspected septic arthritis of axial joints, particularly in the acute stage. Furthermore, it is helpful for evaluation of possible periarticular abscess formation and can serve as a guide for a percutaneous drainage procedure. Computed tomography can also be used when articular bone erosion or medullary extension of osteomyelitis is suspected but not fully documented by conventional radiography.
Many physicians are unfamiliar with the characteristics of the sternocostoclavicular joint (SCCJ). Disorders of the SCCJ, although common, frequently escape recognition. Computed tomography (CT) with thin slices and no gap is at presentthe best means of investigating the SCCJ. CTfeatures in normal subjects have been described in detail; some are misleading. The most common SCCJ disorder is degenerative disease manifesting as osteoarthritis or as periarticular lesions causing antero-medial dislocation of the clavicle. Septic arthritis is the most severe disorder and can lead to mediastinitis. All inflammatory joint diseases, including spondyloarthropathies, can affect the SCCJ. SCCJ involvement is a typical component of the osteoarticular manifestations seen in patients with palmoplantar pustulosis.
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Following traumatic retrosternal dislocation of the clavicle, the patient presented with thoracic outlet syndrome 6 months postinjury with swelling and cyanosis of the right upper extremity, and cramps of the right arm and forearm after heavy manual work. When open reduction of the dislocated clavicle failed, the medial half of the clavicle was resected. Four years postoperation, the patient is doing well, and is asymptomatic. A review of the literature, anatomy, mode of injury, mechanism of injury, pathology, clinical picture, diagnosis and treatment are discussed.
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The manubriosternal joint is commonly involved in rheumatoid arthritis but rarely gives rise to symptoms. A patient is reported with seropositive, erosive rheumatoid arthritis, who developed symptoms resembling pleuritic pain, arising from synovitis of the manubriosternal joint. Treatment with intra-articular steroid injection resolved these symptoms rapidly.
Imaging of inflammatory disorders of the spine and sacro-iliac joints is important for the diagnosis, prognosis, and evaluation of therapy. Conventional radiography still constitutes the basic imaging modality, but supplementary computed tomography (CT) and especially magnetic resonance imaging (MR-scanning) may provide additional important information. The radiation dose by CT must be taken into account. It is therefore expected that MR-scanning, which is without known risks, will increasingly become the method of choice when the information obtained by conventional radiography is inadequate.
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