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PubMed2003

Complications of treatment of acromioclavicular and sternoclavicular joint injuries.

Although common, AC joint injuries and their treatments are not benign. The injury itself and both nonsurgical and surgical treatments may result in complications yielding persistent pain, deformity, or dysfunction. Sternoclavicular joint injuries are far less common and are typically the result of higher energy trauma. As such, the associated complications may be more serious. Familiarity with the potential complications of these injuries can help the treating physician to develop strategies to minimize their incidence and sequelae.

Acromioclavicular Joint↗
PubMedDate not supplied

Sternoclavicular joint hypertrophy following radical neck dissection.

The classic radical neck dissection continues to dominate therapy for cervical metastasis. While the morbidity, complications, and sequelae of this procedure are well documented, sternoclavicular joint hypertrophy appears to have escaped attention. In order to establish the true incidence of this frequently noted but poorly documented condition, 50 randomly selected patients who had undergone radical neck dissection were evaluated retrospectively. Significant sternoclavicular hypertrophy was noted in 54% of the patients, but in only 4 (8%) was the condition severe enough to cause patient or physician concern. Surgical exploration was performed in 2 cases. The etiology of this condition is discussed, as are the radiologic findings, which may be suggestive of metastasis. The major clinical significance is an awareness of the condition and avoidance of over investigation and surgical exploration except in the most suspicious circumstances.

Follow-Up Studies↗
PubMed1996

Ipsilateral sternoclavicular joint dislocation and clavicle fracture.

A case of an ipsilateral sternoclavicular (SC) joint dislocation and clavicle fracture is reported. Two hours postinjury an open reduction and internal fixation of the fractured clavicle was performed using a Kirschner wire plus a stainless steel cerclage wire. This was followed by a surgical repair of the SC joint capsule. The Kirschner wire and cerclage wires were removed 10 months later. The patient had complete recovery of shoulder function.

Adult↗
PubMedDate not supplied

Pseudo-dislocation of the sternoclavicular joint.

Fractures of the medial third of the clavicle are the rarest of all clavicle fractures. We present two cases of medial clavicle fracture nonunions that were initially thought to be chronic anterior sternoclavicular dislocations and describe the entity of pseudo-dislocation of the sternoclavicular joint. Computed tomography should be performed on all patients with suspected or established injuries of the sternoclavicular region to ensure differentiation between fracture and dislocation.

Aged↗
PubMed1985

Computed tomography of the glenohumeral and sternoclavicular joints.

Cross-sectional image display and high contrast resolution of computed tomography underscore the importance of this modality in the evaluation of a wide variety of abnormalities involving the glenohumeral articulation. Computerized arthrotomography provides a more comprehensive examination of the glenohumeral joint when compared with conventional arthrotomography. Furthermore, it requires less technical expertise to perform and is better tolerated by symptomatic patients. Computerized arthrotomography appears to be an ideal imaging method for evaluation of the Hill-Sachs defect and may prove to be the best imaging technique in the assessment of abnormalities of the bicipital tendon and sheath. In addition, the cross-sectional image display and wide contrast resolution of CT are well suited to the evaluation of the sternoclavicular joint.

Adult↗
PubMed2003

Radiographic evaluation of the acromioclavicular and sternoclavicular joints.

Plain radiography is useful for the initial assessment of suspected disorders of the sternoclavicular and acromioclavicular joints. Other modalities are often required to further assess more complex pathologies involving these joints, however. Ultrasound has been described as a screening tool to assess possible sternoclavicular joint dislocation; however, it is usually used only if CT and MRI are not readily available. It has also been used to confirm intraoperative relocation. Ultrasound has a limited role in the evaluation of the AC joint, where it is most useful to exclude the presence of joint inflammation. If joint fluid is detected sonographically, it is considered a nonspecific finding, which could represent active inflammation or simply joint effusion due to degenerative arthrosis. CT allows for excellent visualization of the articular surfaces, osseous changes, subtle or complex fractures, and joint malalignment, with a rapid scan time, making it particularly helpful in the work up of trauma patients. With its multiplanar capabilities and superior soft-tissue resolution, MRI is a very effective modality for characterizing soft-tissue injuries, inclusive of ligamentous tears and cartilaginous injuries. In the specific case of posterior sternoclavicular dislocations, both CT and MR angiography can be very helpful in elucidating occult associated vascular injury.

Acromioclavicular Joint↗
PubMed1991

Candida albicans septic arthritis and osteomyelitis of the sternoclavicular joint in a patient with human immunodeficiency virus infection.

A 52-year-old intravenous drug user, seropositive for human immunodeficiency virus, developed Candida albicans fungemia and septic phlebitis due to an infected peripheral plastic intravenous catheter. Amphotericin B produced quick resolution of fungemia and systemic toxicity, but in the midst of treatment, after 647 mg of amphotericin B, he developed sternoclavicular osteomyelitis and arthritis due to Candida albicans. He responded well to surgical debridement and continuance of antifungal therapy. This is the only case to our knowledge of Candida albicans arthritis and osteomyelitis occurring either in a patient infected with human immunodeficiency virus or in the sternoclavicular joint.

Arthritis, Infectious↗
PubMed1990

Beta 2-microglobulin amyloidosis: a sternoclavicular joint biopsy study in hemodialysis patients.

The incidence of beta 2-microglobulin deposits appears to increase with time on dialysis. However, the precise prevalence of the disease is not known at present because adequate, noninvasive diagnostic procedures are still lacking. We performed systematic synovial biopsies of the sternoclavicular joint during surgical parathyroidectomy in 22 chronic hemodialysis patients with severe hyperparathyroidism. Nine of the patients proved to have beta 2-microglobulin amyloid deposits as demonstrated by Congo red staining and by immunofluorescence. They had undergone dialysis for longer time periods (12.6 vs 8.5 years, p less than 0.02) and tended to be older than the 13 amyloid-negative patients. They also had a significantly higher body aluminum overload, as demonstrated by a higher increase of plasma aluminum after desferrioxamine infusion. Finally, the presence of Congo-red-positive deposits correlated well with clinical and x-ray findings suggestive of dialysis amyloidosis.

Amyloidosis↗
PubMed1996

Radiation dose by spiral CT and conventional tomography of the sternoclavicular joints and the manubrium sterni.

UNLABELLED: OBJECTIVE DESIGN AND PATIENTS: Conventional frontal tomography of the sternum has to some extent been replaced by spiral computed tomography (CT). The objective of this study was to analyse this change of procedure in terms of dosimetry by measurement of the radiation dose to individual organs using an anthropomorphic Rando Alderson phantom. RESULTS: The total effective radiation dose in examination of the sternoclavicular joints and the manubrium sterni was found to be lower using spiral CT than conventional tomography, the values being 0.6 and 0.8 mSv, respectively. CONCLUSION: As spiral CT is diagnostically comparable and in some respects superior to tomography, its use is recommended for studies of the sternum.

Humans↗
PubMed2000

Bilateral sternoclavicular joint tuberculosis.

A unique case of bilateral sternoclavicular tuberculosis is presented, with discussion of the possible mechanism of infection. Early diagnosis is mandatory for good results, and with a world-wide resurgence of this disease, a high index of suspicion is mandatory (especially in immunocompromised patients and migrant populations). Computed tomography and magnetic resonance imaging are helpful for defining the exact extent of the disease.

Adult↗
PubMed1986

Osteoarthritis of the sternoclavicular joint. Radiographic features and pathologic correlation.

Osteoarthritis (OA) of the sternoclavicular (SC) joint has been extensively characterized in the pathology literature, but the radiographic appearance of this entity has received comparatively little attention. To define the radiographic patterns of OA at this joint, we used high resolution PA radiographs (industrial grade film) to examine 55 SC joints obtained by block resection at autopsy. Ten of these also were selected for coronal complex motion tomography. Fifty cases were histologically correlated. Radiographic and pathologic material was evaluated by four criteria characteristic of OA: joint-space narrowing, osteophytes, sclerosis, and cysts. Each criterion was independently assessed for severity and distribution. Moderate or severe radiographic changes of OA were uncommon in specimens younger than age 40, but present in 53% older than age 60. Changes were typically bilateral, although a mild degree of asymmetry was common. OA was most severe along the inferior portion of the clavicular head, which comprises its articulating margin with the sternum. Complex motion tomography was generally more accurate than plain radiography for assessing OA in the ten specimens in which comparison was performed.

Adolescent↗
PubMed1989

[Injuries of the acromio- and sternoclavicular joint--surgical or conservative treatment?].

At the acromioclavicular (AC) joint we distinguish between horizontal instability caused by damage to the AC ligament from vertical instability caused by damage to the coracoclavicular liagments. The most common mechanism of injury is direct force resulting from a fall onto the point of the shoulder. The injury is classified according to the amount of damage brought about by a given force. Horizontal and vertical instability have to be evaluated by special radiographic views. Types I and II are treated by a sling worn for a few days and the application of ice bags. In type III injuries the patient's age, job and acitve pursuits determine whether or not surgery is indicated. In type IV-VI injuries we always perform the operation. We use a resorbable cerclage between the clavicle and the coracoid process and suture all torn ligaments. In the sternoclavicular joint too, the ligamentous stability is of the utmost importance. The sternoclavicular ligament limits the ante- and retroversion of the clavicle, while the costoclavicular ligament limits the upward movement. The direction of subluxation or luxation has to be evaluated by means of an oblique view X-ray with a cephalic tilt of the tube through 40 degrees or by a computed tomogram. In the case of an acute injury closed reduction should always be attempted. Open recuction should only be performed in cases of persistent posterior luxation, because of the numerous complications that are possible in such cases.

Acromioclavicular Joint↗