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At least 19 recordsLinked to original sources
PubMed2005

Interposition arthroplasty with bone-tendon allograft: a technique for treatment of the unstable sternoclavicular joint.

Sternoclavicular joint instability is an uncommon but challenging clinical problem for the orthopaedic surgeon. Although most cases can be treated nonoperatively with minimal long-term pain or functional limitation, a small percentage may require surgical intervention. This includes chronic anterior instability associated with persistent pain or functional limitation as well as irreducible or recurrent posterior instability. Although numerous procedures have been described for treatment of the unstable sternoclavicular joint, the optimal method for stabilization has not been determined. Here we describe a technique using Achilles tendon allograft to create an interpositional arthroplasty and briefly present 3 illustrative cases in which we performed the procedure. We believe this method effectively stabilizes the joint, restores function, relieves pain, and has applications for traumatic sternoclavicular instability as well as instability related to other etiologies.

Achilles Tendon↗
PubMed2006

Adolescent butterfly swimmer with bilateral subluxing sternoclavicular joints.

Sternoclavicular joint subluxation/dislocation injuries in the athlete are uncommon. They can be organised by degree (subluxation, dislocation), timing (acute, chronic, recurrent, congenital), direction (anterior, posterior), and cause (traumatic, atraumatic). The unusual case reported is an adolescent butterfly swimmer with recurrent bilateral sternoclavicular subluxation associated with pain and discomfort. The condition was treated and resolved with conservative management. The diagnosis, investigations, and treatment options are discussed.

Adolescent↗
PubMed1995

Septic arthritis of a lumbar facet joint and a sternoclavicular joint.

STUDY DESIGN: This is a case report. OBJECTIVES: To the authors' knowledge, simultaneous septic arthritis of a lumbar facet joint and another joint has not been described as yet. Therefore, a patient is presented in whom both a lumbar facet joint (L4-L5 on the right) and a sternoclavicular joint were involved. SUMMARY OF BACKGROUND DATA: Septic arthritis of a lumbar facet joint is a rare condition, and only a few cases have been reported in the literature. METHODS: The etiology, clinical presentation, technical examinations, and treatment are reviewed. RESULTS: Antibiotic treatment was sufficient to heal these lesions. CONCLUSION: Antibiotic treatment was sufficient to heal these lesions.

Anti-Bacterial Agents↗
PubMed2003

Treatment and results of sternoclavicular joint injuries.

Sternoclavicular joint injuries are uncommon. The anatomy is not familiar to most orthopaedic surgeons, and there is a high risk of both intraoperative catastrophic and postsurgical complications when performing surgery in this region. Anterior SC joint instability should primarily be treated conservatively. The patients should be informed that there is a high risk of persistent instability with nonoperative or operative care, but that the persistent instability will be well tolerated and have little functional impact in the vast majority. Therefore, operative intervention for anterior SC joint instability is mainly cosmetic in nature. Patients with posterior SC joint dislocations require an expeditious diagnosis and treatment, due to the proximity of the displaced medial clavicle to the great vessels. An early closed reduction will usually be stable. Operative stabilization must, however, be considered if the closed reduction is unsuccessful or there is persistent SC instability. SC joint stabilization should be performed with a soft tissue reconstruction, repairing both the costoclavicular ligaments and the SC capsular envelope.

Arthroplasty↗
PubMedDate not supplied

Atraumatic disorders of the sternoclavicular joint.

The sternoclavicular joint is the diarthrodial articulation between the axial and appendicular skeletons. It is subject to the same disease processes that occur in joints, including degenerative arthritis, rheumatoid arthritis, infection, and subluxation. Most of these conditions present with swelling of the joint, which may be associated with pain and/or tenderness. Plain radiographs can demonstrate changes on both sides of the joint. Because of variations in anatomy, computed tomography scans and magnetic resonance images are often necessary to clarify the pathology. With the exception of acute infection, most conditions can be managed nonsurgically, with joint resection reserved for patients with persistent symptoms.

Arthritis, Rheumatoid↗
PubMed2003

Surgical management of sternoclavicular joint infections.

OBJECTIVE: Sternoclavicular joint infections are rare, and their management is controversial. We reviewed our experience with the surgical management of this condition. METHODS: From August 1988 to August 2001, 26 patients (16 men and 10 women) were treated surgically for infected sternoclavicular joints. The median age was 56 years (range, 20-77 years). Patients who had a recent previous median sternotomy were excluded. RESULTS: All patients were symptomatic. Pain was present in 21 patients, swelling in 14 patients, fever in 11 patients, and erythema in 9 patients. Associated conditions included recent or ongoing infections in other areas in 12 patients (pneumonia in 4 patients, multiple joint infections in 2 patients, and other in 6 patients) and an indwelling central venous catheter in 1 patient. Five patients had a history of trauma in the region of the joint. Four patients had prior joint incision and drainage. Unilateral sternoclavicular joint resection was done in 18 patients, bilateral resection in 2 patients, and incision and drainage with debridement in 6 patients. Wound culture results were positive in 24 patients, and the most common organism isolated was Staphylococcus aureus (n = 17). Eleven patients had transposition of the ipsilateral pectoralis major muscle to obliterate residual space and to reconstruct the chest wall. Two (7.7%) patients had complications, and 1 died (operative mortality, 3.8%). Follow-up was complete in all 25 operative survivors and ranged from 2 months to 10 years (median, 25 months). Twenty-one patients are alive without symptoms, infection, or limitations in range of motion. Four patients have died as a result of causes unrelated to their joint infections. CONCLUSIONS: Symptomatic sternoclavicular joint infections often require surgical intervention. Surgical resection combined with muscle transposition provides effective long-term outcome.

Adult↗
PubMed1997

Aggressive surgical management of sternoclavicular joint infections.

BACKGROUND: Although the sternoclavicular joint is an unusual site for infection, thoracic surgeons may preferentially be called on to coordinate management of cases refractory to antibiotic therapy because of the anatomic relationship of this joint to major vascular structures. METHODS: Since 1994 we have surgically managed nine sternoclavicular joint infections in eight patients. Associated medical problems were frequent and included diabetes mellitus (n = 2), end-stage renal disease (n = 2), hematologic disorders (n = 2), and multiple joints affected by sepsis (n = 4). Open joint exploration with drainage and débridement with the use of general anesthesia was performed in four patients. The remaining four patients (one with bilateral sternoclavicular joint infections) had computed tomographic evidence of diffuse joint and surrounding bone destruction with infection extending into mediastinal soft tissues. Surgical therapy for these five joint infections involved en bloc resection of the sternoclavicular joint with an ipsilateral pectoralis major muscle covering the bony defect. RESULTS: There were two deaths unrelated to the surgical procedure. After a mean follow-up of 20 months, the remaining six survivors (seven joints) have complete healing with no apparent limitation in the range of motion even after en bloc resection. CONCLUSIONS: Most cases of early sternoclavicular joint infections will respond to conservative measures. However, when radiographic evidence of infection beyond the sternoclavicular joint is present, en bloc resection, although seemingly aggressive, results in immediate eradication of all infection with negligible functional morbidity. Prolonged antibiotic therapy or continued local drainage procedures appear to have little value in these cases, adding only to patient care costs and the potential sequelae of chronic infections.

Adult↗
PubMedDate not supplied

Suture anchors for treatment of sternoclavicular joint instability.

Instability of the sternoclavicular joint is a difficult problem to treat and can present with gross limitation in activities. Eight sternoclavicular joint stabilization procedures were performed over an 8-year period. The patients' ages ranged from 16 to 48 years (mean, 23.5 years). The indication for stabilization was pain associated with instability of the sternoclavicular joint. The joint was stabilized by use of suture anchors on the manubrium and capsular plication. The functional outcome was evaluated by use of the Constant score and patient-based Oxford Shoulder Questionnaire. At a mean follow-up of 4.5 years (range, 1-7.6 years), none of the patients had instability at the sternoclavicular joint, and all except one had returned to their previous employment. The Oxford score was 16 (range, 12-38). The mean Constant score was 74.88 (range, 33-87). We had only 1 poor result (Constant score of 33). Stabilization of the sternoclavicular joint can safely be performed by use of suture anchors. The technique is recommended for symptomatic sternoclavicular joint instability.

Adolescent↗
PubMed2002

Pictorial review: MRI of the sternum and sternoclavicular joints.

The sternum and sternoclavicular joints are difficult to evaluate with plain radiographs. The value of CT in assessing lesions of the sternum and sternoclavicular joints has been well documented, but the potential role of MRI has not been emphasized. We present the MRI techniques, normal appearances and a spectrum of abnormalities, and emphasize the role of MRI as a useful radiological investigation for the sternum and sternoclavicular joints.

Bacterial Infections↗
PubMed2002

Resection arthroplasty of the sternoclavicular joint for the treatment of primary degenerative sternoclavicular arthritis.

We describe the mid-term clinical results of the surgical treatment of primary degenerative arthritis of the sternoclavicular joint in eight women. They had not responded to conservative treatment and underwent a limited resection arthroplasty. For pre- and postoperative clinical evaluation we used the Rockwood score for the sternoclavicular joint. Postoperatively, the Constant score was also determined. The mean follow-up was 31 months (10 to 82). The median Rockwood score increased from 6 to 12.5 points. The median postoperative Constant score was 87 (65 to 91). Four patients had an excellent, three a good, and one a poor result. All patients were pleased with the cosmetic result. Resection arthroplasty is an effective and safe treatment for chronic, symptomatic degenerative arthritis of the sternoclavicular joint with a high degree of patient satisfaction.

Arthroplasty↗
PubMed1997

A method for open reduction and internal fixation of the unstable posterior sternoclavicular joint dislocation.

Posterior sternoclavicular joint (SCJ) dislocations are most often stable after reduction but may be associated with significant complications related to the location of the medial head of the clavicle within the mediastinum. In rare instances, a posterior SCJ dislocation is irreducible or redislocates after a closed reduction. Because of the potential hazards related to compression of vital structures within the superior mediastinum, open reduction and internal fixation is usually required. Although open reduction is widely accepted as the method of choice, the best method for achieving stable fixation remains unanswered. We present the case of an unstable SCJ stabilized, in anatomic position, with two large-bore cannulated screws in conjunction with open reduction. We believe that the risk of hardware migration reported with the use of pins and wires and its catastrophic complications are greatly minimized using our technique.

Adult↗
PubMed1993

Dislocations of the sternoclavicular joint.

Dislocations of the sternoclavicular joint are uncommon, with the posterior variety having a potential for considerable morbidity. Radiologic management and diagnosis can be difficult. In this review article, the joint anatomy and mechanisms of dislocation are discussed and the incidence and clinical manifestations described. Six case reports are presented to illustrate causative mechanisms, diagnoses, and radiologic appearances. Computed tomography is the best method of demonstrating the sternoclavicular joint, but a number of specialized plain film projections are also described and illustrated; these should be more widely known. Treatment of the joint dislocations is briefly discussed.

Adolescent↗
PubMed1979

Computed tomography in the diagnosis of dislocations of the sternoclavicular joint.

Dislocations of the sternoclavicular joint can be easily characterized with computed tomography. Two typical cases, one demonstrating superior dislocation and the other showing posterior dislocation of the clavicle, illustrate the value of the method. Correlated anatomical observations demonstrate the proximity of the great vessels to the sternoclavicular joint.

Adolescent↗
PubMedDate not supplied

[Diagnosis and therapy of sternoclavicular joint dislocation].

Luxation of the sternoclavicular joint is described on the basis of the case histories and progress of patients with this very rare form of injury who underwent surgical treatment on the Orthopedic Clinic of Düsseldorf University Hospital in the years 1978 to 1988. Four of the 6 patients in our study were subjected to a follow-up examination as out-patients. After preliminary remarks on the anatomical and biomechanical peculiarities of the sternoclavicular joint, the various types of luxation and the customary Allmann I-III classification for degree of severity are discussed. Surgical treatment is essential only for injuries of the IIIrd degree. Dislocation of the sternal end of the clavicle is most frequently found ventrad, as was also the case in all 6 patients in our study; the rarest finding is dorsad. The symptoms and the necessary diagnostic measures are described. Surgical treatment of the retrosternal luxation of the sternoclavicular joint is indicated as absolutely essential on account of the possibility of life-threatening complications. A relative indication of operative treatment exists for anterior luxation of the sternoclavicular joint where severe functional impairment and pain are present, e.g. during work and sport. The various operative methods currently in use are described. Reference is made to the importance of imaging techniques. A warning is given that, because of the risk of fatal complications, Kirschner wiring should not be used for retention of the reduction unless the K-wires are reliably secured.

Adult↗
PubMed1998

Tuberculosis of the sternoclavicular joint. Report of two cases.

The sternoclavicular joint accounts for only 1 to 2% of all cases of peripheral tuberculous arthritis and is more often infected by pyogenic organisms than by the tubercle bacillus. We report two cases of sternoclavicular joint tuberculosis, in a 38-year-old man and a 46-year-old woman without risk factors for immune deficiency. Swelling of the joint was the presenting manifestation. Laboratory tests indicated inflammation in only one of the patients. The intradermal tuberculin test was strongly positive in both patients, whereas smears and cultures of sputum and urine samples were negative for the tubercle bacillus. Serologic tests for the human immunodeficiency virus were negative. Erosions of the affected joint were seen by computed tomography. Histological studies of a surgical biopsy specimen confirmed the diagnosis. Cultures of the biopsy specimens were negative. The outcome was favorable after treatment with rifampin, isoniazid and pyrazinamide for six months in the man and nine in the woman. Follow-ups were eight and six months, respectively, at the time of this writing. Tuberculosis of the sternoclavicular joint is extraordinarily rare and can raise diagnostic problems. The diagnosis should be considered in every patient with arthritis in a sternoclavicular joint or unexplained pain in a shoulder. Possible complications include compression or erosion of the large blood vessels at the base of the neck and migration of tuberculous abscesses to the mediastinum.

Adult↗
PubMed2003

Stability of the sternoclavicular joint. A retrospective study.

Enlargement of the sternoclavicular joint is a well-documented but little recognised complication of radical neck dissection [AJR 3 (1971) 584]. We examined the stability of the sternoclavicular joint in 61 patients who had had radical neck dissection, functional neck dissection or sternomastoid division in the treatment of torticollis. Our findings support the hypothesis that postoperative stability of the sternoclavicular joint depends on the integrity of the accessory nerve and probably the proprioceptive branches of C3 and C4 of the cervical plexus. We conclude that in patients who require surgical section of the sternomastoid muscle in the treatment of torticollis, or for venous access in microvascular reconstruction, enlargement of the sternoclavicular joint should not occur as a postoperative complication, unlike those patients who have radical neck dissection with resection of the accessory nerve.

Accessory Nerve↗