Atraumatic Sternoclavicular Joint Instability: Prevalence, Etiology, and Management

Sternoclavicular joint instability is a rare complaint in the orthopedic clinic, but patients can experience chronic pain and functional impacts. Causes of instability may be posttraumatic, infectious, autoimmune, degenerative, or secondary to generalized laxity. Conservative treatment is the initial approach to management and involves activity modification, physical therapy, oral nonsteroidal anti-inflammatory drugs, and corticosteroid injections. Surgery is indicated when conservative treatment does not manage symptoms. Figure-of-eight reconstruction techniques provide greatest biomechanical strength but are associated with risk of neurovascular injury. Other reconstruction methods have been shown to mitigate these risks with favorable short-term outcomes.

Clostridium Perfringens Septic Arthritis of the Sternoclavicular Joint

BACKGROUND

Clostridium perfringens septic arthritis of the sternoclavicular joint has not been reported previously.

CASE REPORT

We present the case of a 70-year-old patient with a history of stage IV colon cancer who presented to the emergency department with chest and neck pain for 3 days. After assessment, he was discharged home on analgesics. Within 24 h he returned, critically ill with C. perfringens septic arthritis of the left sternoclavicular joint and septic shock. Why Should an Emergency Physician Be Aware of This? Emergency physicians should be aware of the possibility of C. perfringens sternoclavicular joint septic arthritis in patients with unexplained chest, shoulder, or neck pain, especially when associated with a history of colorectal carcinoma or immunosuppression. A finding of C. perfringens bacteremia should prompt a search for occult gastrointestinal malignancy.

[Salter 1 medial collarbone epiphysiolysis with acute posterior displacement in the immature skeleton]

Sternoclavicular epiphysiolysis is a rare lesion, the posterior variant being even less common. Its clinical presentation may be subtle, or it may compromise mediastinal structures, either initially or during evolution, which is a serious and potentially fatal picture. This case report documents sternoclavicular dissociation in a patient with an immature skeleton, given by a Salter and Harris 1-type injury, which was surgically treated by open reduction and internal fixation with transosseous configuration with non-reabsorbable suture. With a 10-month follow-up and excellent results. This technique seems to be a good option for the treatment of sternoclavicular dislocation in the schematically immature patient, regaining function and avoiding complications.

[Treatment of traumatic anterior dislocation of sternoclavicular joint with allogeneic tendon of "W" type knit]

OBJECTIVE

To investigate effectiveness of allogeneic tendon of "W" type knit in repair of traumatic anterior dislocation of sternoclavicular joint.

METHODS

Between June 2013 and June 2017, 12 patients with traumatic anterior dislocation of sternoclavicular joint after poor conservative treatment were treated with allogeneic tendon of "W" type knit. Of them, 10 were males and 2 were females, aged from 25 to 58 years (mean, 42 years). All injuries were caused by traffic accidents. The time from injury to operation was 4-12 weeks (median, 6 weeks). All of them were closed injuries. The patients had no fracture around the shoulder, or blood vessels, nerves, and other adjacent limb joint injuries. The operation time, intraoperative blood loss, incision healing, and complications were recorded. The sternoclavicular joint was observed by X-ray film and CT at 1 year after operation. Visual analogue scale (VAS) score, University of California Los Angeles (UCLA) score, Rockwood score, modified Hospital for Special Surgery (HSS) score, and Constant-Murley score were used to evaluate the function of shoulder joint after operation.

RESULTS

The operation time was 60-80 minutes (mean, 70 minutes). The intraoperative blood loss was 50-100 mL (mean, 60 mL). Primary healing of incision was obtained in all patients without complications. All the patients were followed up 12-24 months (mean, 18 months). At 1 year after operation, X-ray film and CT examination showed that the position of sternoclavicular joint was satisfactory. At 1 year after operation, the Rockwood score was 12-14 (mean, 13). The UCLA score was 28-34 (mean, 31). The VAS score was significant lower than that before operation ( P<0.05), and the Constant-Murley score and modified HSS score were significantly higher than those before operation ( P<0.05).

CONCLUSION

The repair of traumatic anterior dislocationr of sternoclavicula joint with allogeneic tendon of "W" type knit can effectively reconstruct the stability of the joint, retain the physiological fretting, and obtain satisfactory results.

Clavicle Trauma: From Acromioclavicular Joint Injuries to Distal Clavicle Fractures and Midshaft Fractures in Contact Athletes

Injuries to the clavicle and its articulations (the acromioclavicular and sternoclavicular joints) are becoming increasingly common. Conventional treatment has been dominated by nonsurgical techniques; however, the active patient was often left with substantial residual disability that was underreported. It is now recognized that surgical intervention may be advantageous in specific patients, especially athletes. Surgeons should consider pathophysiology, indications, and surgical techniques to best manage these injuries.

T-plate fixation for unstable proximal clavicula fractures

Objective

The aim of this study was to evaluate the clinical results of T-plate fixation and anterior sternoclavicular ligament repair in proximal clavicle fractures.

Methods

Between August 2013 and August 2016, a total 12 patients (10 men and 2 women; mean age: 44.1 ± 9.1 years (range, 25–59 years)) with unstable proximal clavicle fractures (Throckmorton, type D) were treated with T-type plate fixation, bridging the sternoclavicular joint, and anterior sternoclavicular ligament repair. Average operative time, associated injuries, postoperative complications, postoperative fracture healing time and follow-up time were recorded. The outcomes were evaluated with radiographic assessment, visual analog scale (VAS) pain score and Rockwood SCJ scoring system. All the patients were evaluated on postoperative 3rd, 6th, and 12th months.

Results

The average surgery time was 78.0 ± 8.47 minutes while fracture healing time was 4.51 ± 0.95 months. According to Rockwood SCJ scoring system, 9 cases (75%) were in excellent, 2 cases (16.7%) in good and 1 case (8.3%) in fair condition at 12 months follow-up. The average Rockwood SCJ score was 7.7 ± 0.75 preoperatively, 12.7 ± 0.86 by 3 months, 13.0 ± 0.73 by 6 months and 13.3 ± 0.49 by 12 months. The VAS pain score was 7.9 ± 1.15 (preoperative score), 3.4 ± 1.52 (3 months follow-up), 3.0 ± 1.32 (6 months follow-up) and 2.1 ± 1.07 (12 months follow-up). The VAS and Rockwood SCJ scores were significantly improved postoperatively (p < 0.05). There was no intraoperative complication, while one patient had redislocation of the sternoclavicular joint after implant removal.

Conclusion

T-type plate fixation with anterior sternoclavicular ligament repair might be a reliable and effective treatment method in unstable proximal clavicle fractures (type D) with few complications and satisfactory clinical results after 12 months follow-up.

Level of evidence

Level IV, therapeutic study.

Tuberculosis of the Sternoclavicular Joint: Report of Three cases

Ebstein's anomaly accounts for 0.3% to 0.7% of all cases of congenital heart disease. The condition is characterized by abnormal tricuspid valve and right ventricle with apical displacement of tricuspid valve leading to atrialization of right ventricle. There have been case reports of patients surviving up to ninth decade. It is unusual for these patients to be asymptomatic in adulthood for long duration. We describe a patient with Ebstein's anomaly in the ninth decade with coronary artery disease.

[One-stage resection of intravenous leiomyomatosis extending into the right atrium]

Intravenous leiomyomatosis (IVL) is a benign tumor that originates from a uterine myoma and rarely extends to the heart through the inferior vena cava (IVC). Echocardiography revealed an abnormal mass in the right atrium in a 63-year-old asymptomatic woman. Preoperative examination revealed a tumor extending from a myoma through the right internal iliac vein to the right atrium, and the patient was diagnosed with IVL. She underwent sternotomy combined with laparotomy, and the intravenous and intracardiac tumor was removed under normothermic cardiopulmonary bypass without cardiac arrest. Hysterectomy and bilateral adnexectomy were also performed. No additional therapy was required after surgery.

[Refractory methicillin-resistant Staphylococcus aureus empyema invasion from a cervical abscess: report of a case]

The patient was a 68-year-old male. At the previous hospital, continuous hemodiafiltration (CHDF)was performed through internal jugular vein for diabetic nephropathy. Long term catheterisation caused the abscess of the sternoclavicular joint, which induced methicillin-resistant Staphylococcus aureus( MRSA) empyema. Endoscopic thoracic debridement was performed for the empyema, however inadequate drainage for the abscess. Thereafter, the patient transferred to our hospital. We performed adequate drainage for the abscess under general anesthesia at 5 days after hospitalization, and then open decortication for empyema at 26 days. The patient recovered well after operation and was discharged from the hospital at 46 days. This was a successful case of surgical treatment for refractory MRSA empyema, which controls all focus of infection.

[Sternoclavicular joint ganglion]

The sternoclavicular joint is subject to the same disease processes than the rest of the joints; it is a synovial joint. Ganglions are circumscribed tumors associated to a synovial structure; their highest incidence is in the wrist dorsum, but they may be found in all the joints with a synovial structure. The etiology of ganglions includes degenerative, traumatic, congenital causes and inflammatory processes. We describe herein the case of a 6 year old female patient with a ganglion in the sternoclavicular joint, with a traumatic origin and symptomatic upon performing physical activity. Ultrasound of the sternoclavicular joint was performed; treatment included puncture, aspiration and methylprednisolone injection. The observation of asymptomatic patients is a perfectly reasonable treatment plan.

[Sternoclavicular joint tuberculosis]

A 24-year old woman presented with an abscess localized at the median side of the right clavicle. There were no clinical signs of tuberculosis and radiological evaluation was normal. PCR-assay on tuberculosis following aspiration of the pus collection was positive for Mycobacterium tuberculosis. She responded well on regular anti-tuberculosis treatment.

[Arthritis sternoclavicularis as a cause of mediastinitis]

Sternoclavicular arthtritis is a condition of the joints and movement apparatus which is treated by Rheumatologists and Orthepedists. Incorrect or late treatment of this condition leads to the development of septic arthritis and overall complications. This report describes three rare cases of mediastinitis caused by inflammation of the sternoclavicular joint. The authors analyze the possibilities of surgical treatment and early diagnosis.

Off-pump coronary bypass via left thoracotomy resulting from sternoclavicular arthritis

We report a case of coronary artery bypass grafting through the left thoracotomy in a patient who suffered from sternoclavicular joint infection with methicillin-resistance Staphylococcus aureus. We performed off-pump coronary bypass surgery, using the left internal thoracic artery to the left anterior descending coronary artery and a saphenous vein graft from the aorta to the circumflex artery, with a successful outcome. This approach seems to be safe and effective for coronary bypass grafting in situations where median sternotomy is not favorable, as in the described patient.

[A case of sternoclavicular joint tuberculosis with renal failure due to rifampicin]

A 79-year-old man was admitted to a previous hospital complaining of left precordial swelling. Chest CT scan showed destruction of left sternoclavicular joint and a mass of 5 cm in diameter. Needle biopsy was performed and the diagnosis of sternoclavicular joint tuberculosis was made on the basis of presence of M. tuberculosis in the specimen. The patient was treated with isoniazid, ethambutol, rifampicin, and pyrazinamid but he developed renal failure. Then, he was transferred to our hospital. All medications were suspended because of the possibility of the side effect of drugs. We performed renal biopsy and histopathological examination revealed interstitial nephritis and minimal-change glomerulonephritis. From the result of examination, we considered interstitial nephritis was due to rifamicin. The treatment with 50 mg/day of prednisolone and isoniazid, ethambutol, and levofloxacin was administrated and renal failure and precordial mass were improved. Tuberculous arthritis usually affect hip and knee joint and sternoclavicular joint involvement is very rare.

[Clinical observation of sternoclavicular joint dislocation fixed by clavicular hook plate]

OBJECTIVE

To analyze the treatment of the sternoclavicular joint dislocation by clavicular hook plate and investigate its clinical value to find a therapy with more safety and stability.

METHODS

Between January 2003 and January 2007, 15 patients with sternoclavicular joint dislocation were involved, among whom there were 12 males and 3 females, aged 28-45 years old (34 on average). There were 12 cases of falling injury and 3 cases of vehicle accident injury. The course of disease was 1-12 hours. A total of 2 cases were on the left side and 13 were on the right side. There were 14 cases of anterior dislocation and 1 of posterior dislocation. Two patients were complicated by acromioclavicular joint dislocation with no pneumothorax, and 2 patients had a little pleural effusion without any special treatment. As to the damage degree, according to the Grade system, there were 2 cases of type II and 13 cases of type III.

RESULTS

All patients' incisions obtained healing by first intention after operation. The X-ray films showed that the reduction of joint dislocation and the location of internal fixation were good. All the 15 patients were followed up for 6-18 months (14 months on average). All cases were scored by Rockwood after the operation to assess the curative effect, with 12 excellent, 2 good and 1 fair. There was no wound infection, neurovascular injury, hemopneumothorax, internal fixation failure, redislocation or other side injuries. The anatomical structure as well as appearances and functions were restored.

CONCLUSION

The fixation of clavicular hook plate in treating sternoclavicular joint dislocation has superiority over other methods with more stability, less risk and small chances of cardiovascular injury. Besides, the patients can do functional exercises early and the shoulder joint function can be improved to the maximal degree.

A case report and review of the literature

Septic arthritis of the sternoclavicular joint is rare. Its causes have been reported to include immuno-compromizing diseases, intravenous drug abuse, fractures of the clavicle or catheterization of the subclavian vein. We report a case of septic arthritis of the SCJ in a diabetic patient following periarticular injection of steroids in the ipsilateral shoulder, as this route of infection has not been documented, to our knowledge, in the literature to date. We review the literature regarding epidemiology and methods of surgical treatment that have been proposed, and present our own surgical experience. Bacterial infection should always be suspected in cases of SCJ arthritis. If surgery is required, it is important to remember that bony procedures leave vascular structures exposed, making their cover by myoplasty mandatory.

[Sterno-clavicular plasty in anterior dislocation in child. The new surgical technic and review literature]

The sternoclavicle joint takes part in stability and normal rotation of clavicle in shoulder movement. Its injury infrequent and the luxation in children is more rare. It is classified in previous and retrosternal. The most common causes are by sport trauma and car accidents. In children differential diagnosis includes proximal epiphyseal displacement of clavicle. The clinical picture is pain, sternum or thorax deformity and limitation in range of motion of the arm. The treatment is conservative or surgical, and indications to surgical treatment are pain when moving, range of motion limitation or concomitant complications. In the surgical treatment, the reduction of the clavicle is made with a percutaneous clamp and then protecting the position with a bandage in "eight". Other options are open reduction of the clavicle and subclavian plasty, reduction open and to make plastias with grafts of subclavio,fascia latae or proximal third clavicle resection and cerclage with wire. We present a clinical case and surgical treatment with a novel surgical technique.

Management of sternoclavicular joint infections

Surgically managed infections of the sternoclavicular joint have rarely been reported, but general and thoracic surgeons may be consulted to manage such infections. Patients who have demonstrated resistance to antibiotic therapy or have infection extending beyond the joint capsule are best managed by surgical resection.

[Tuberculosis of the sternoclavicular joint]

Tuberculosis is seen in every part of the body, but sternoclavicular joint tuberculosis is rare. We report a case of tuberculosis of the sternoclavicular joint in 70-year-old woman having complained of the right sternoclavicular joint swelling. She had a previous history of pulmonary tuberculosis, and visited her doctor for right sternoclavicular joint swelling on February 2006. A chest CT scan showed a low density area with destructive osseous changes in the right sternoclavicular joint. Definite diagnosis could not be done by twice needle biopsy, but we diagnosed her as tuberculosis of the sternoclavicular joint based on the clinical course and the findings of the examination. As her condition did not improve after 3 months treatment with anti-tuberculous drugs, we conducted therapeutic surgical procedure. Definite diagnosis of sternoclavicular joint tuberculosis was made on the basis of the presence of mycobacteria in the histological specimen and PCR-TB positive result. We kept the wound opened and continued administration of anti-tuberculous drugs, and her condition does not deteriorate. Tuberculosis should be considered in case of a patient with arthritis and previous history of tuberculosis, even if it is seen in rare location. Diagnostic and therapeutic surgical procedure should be taken into consideration, if there is no improvement of the condition after a diagnosis of bone and joint tuberculosis, and the administration of chemotherapy for tuberculosis.

Staphylococcal septic synovitis of the sternoclavicular joint with retrosternal extension

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 joint pseudo-tumour: a case report and literature review

This case report describes the development of a post-treatment enlargement of the sternoclavicular joint, diagnosed as a pseudo-tumour, in a patient who had previously undergone radical neck dissection and post-operative radiotherapy for metastatic mucoepidermoid carcinoma. Although pseudo-tumour has been previously reported in the surgical literature, it remains an uncommonly recognized condition. We present a review of the literature and discuss the condition's pathogenesis. We also highlight its importance to both the surgeon and the oncologist when considering the differential diagnosis of a swelling in the clavicular region, typically occurring following radical surgery for malignant disease in the neck.

Posterior sternoclavicular dislocations: a review of management and complications

Posterior sternoclavicular dislocations are relatively uncommon injuries. Nevertheless, these dislocations are associated with potentially fatal injuries to the mediastinum and the great vessels. Medial clavicle physeal injury with posterior dislocation may present with a similar clinical picture in younger patients. There is a wide variety of techniques for managing these injuries. In this article, we review recent techniques for reducing and managing posterior sternoclavicular dislocations.

Stress fracture of the clavicle associated with sternocostoclavicular hyperostosis

We report a case of stress fracture of the clavicle associated with sternocostoclavicular hyperostosis. A 60-year-old man sustained a stress fracture of the right clavicle with no history of trauma. On radiography, hyperostosis of the anterior chest wall and ankylosis of the sternoclavicular joint were evident in addition to the fracture. Fracture healing was uneventful after 2.5 months. Ankylosis of the sternoclavicular joint may have caused increased stress at the midshaft of the clavicle by daily activity or minor trauma. Such a fracture is a rare complication of sternocostoclavicular hyperostosis.

Septic arthritis as a late complication of carcinoma of the breast

OBJECTIVES

To see if a past history of radiation therapy is a risk factor for septic arthritis.

METHODS

We retrospectively searched our records of 282 patients with septic arthritis and found 10 cases of septic arthritis post-radiotherapy, all in females. We analysed our group, correlating them with the literature. We also compared our patients with a group of septic arthritis patients without radiation therapy.

RESULTS

Nine had had radiation therapy for carcinoma of the breast. The shoulder joint was involved in six and the sternoclavicular joint in three. The tenth patient had had brachytherapy and radiation for carcinoma of the cervix and presented with septic arthritis of the hip. The mean age of the patients was 69 yr (49-82 yr). The mean time elapsed since radiation was 16 yr (3-34 yr). Twenty-three cases of shoulder septic arthritis in patients without past radiation therapy were selected for comparison. The five patients with past radiation therapy had fever less often and a longer time lapse before diagnosis. They required longer antibiotherapy. However, this prevented neither bone destruction nor relapse.

CONCLUSIONS

In our study, a past history of radiation therapy was observed in 6/50 infections of the shoulder, 3/5 infections of the sternoclavicular joint, 6/23 cases of septic arthritis of the shoulder and all cases of septic arthritis of the sternoclavicular joint for females. Radiation therapy seems to be a risk factor for septic arthritis. Diagnosis would be aided by a greater awareness of the clinical and radiological features of this septic arthritis.

Anterior subluxation after reduction of a posterior traumatic sterno-clavicular dislocation: a case report and a review of the literature

Sternoclavicular dislocations represent a rare injury. Based on our clinical experience with a patient showing an anterior subluxation after reduction of a posterior traumatic dislocation, we review the literature. The emergent reduction of the dislocation is mandatory, always keeping in mind the potentially devastating neurovascular complications. If the treatment of a residual anterior instability remains controversial, a residual posterior instability should be treated by a surgical procedure. The optimal treatment depends mainly on each surgeon's choice and practice.

Pseudomonas sternoclavicular pyarthrosis

Most cases of Pseudomonas pyarthrosis affecting the sternoclavicular joint have been reported in immunosuppressed intravenous drug users. We report a case of Pseudomonas pyarthrosis in a man who was otherwise immunocompetent, except for his age. A 66-year-old white man presented to the clinic with a 1-month history of right-sided shoulder and arm pain associated with swelling of the upper part of the chest in the region of the right sternoclavicular joint. The chest radiograph revealed opacity in the right superior mediastinum. Computed tomography scan of the chest confirmed a mass in the right sternoclavicular region with associated osteolysis of the clavicular head. A needle biopsy of the mass was negative for malignancy. An open biopsy specimen showed evidence of chronic inflammation without evidence of malignancy, and culture of the tissue grew Pseudomonas aeruginosa. The patient's symptoms improved after extensive incision and drainage of the affected area followed by treatment with antibiotics for 6 weeks.

Atraumatic retrosternal dislocation of the clavicle

Atraumatic retrosternal dislocation of the clavicle is an exceedingly rare event and three out of four previously reported cases lack any radiological evidence. We report the case of a 30-year-old male patient who presented an atraumatic retrosternal dislocation of the clavicle without a history of previous injury and underlying pathology. The diagnosis was delayed and established by a CT scan ten days after and initial presentation of the symptoms. A successful, stable, closed reduction under general anaesthesia was performed ten days after the initial presentation, having a cardiothoracic surgeon immediately available. There was no recurrence and the patient remains asymptomatic 18 months later.

Bilateral retrosternal dislocation and hypertrophy of medial clavicular heads with compression to brachiocephalic vein

A 36-year-old woman with effort dyspnea for 2 years, venous congestion of the left arm for 6 months and who did not have a history of a thoracic trauma was hospitalized. Posterior bilateral dislocation of the sternoclavicular joints and compression of the brachiocephalic vein were diagnosed and conformed by computed tomography (CT). The joint could not be reduced because of the old dislocation and destruction of the joint in the operation. The heads of the clavicles were resected and the vein compression was eliminated. Six weeks later, venous congestion disappeared and the brachiocephalic vein was patent.

Sternoclavicular joint septic arthritis manifesting as a neck abscess: a case report

Septic arthritis of the sternoclavicular joint is an uncommon condition, and the diagnosis can be missed until a complication occurs. The sternoclavicular joint is more often involved in ankylosing spondylitis, degenerative arthritic conditions (i.e., rheumatoid arthritis and osteoarthritis), and primary and secondary metastatic conditions. The patient described in this case report came to the otolaryngology department on two occasions for treatment of a unilateral cutaneous neck abscess. The correct diagnosis was not made until the second visit. The author reviews the clinical course, diagnosis, and treatment of this uncommon disease.

Sternoclavicular joint infection in an adult without predisposing risk factors

Septic arthritis of the sternoclavicular joint (SCJ) is an uncommon condition and it has been associated with numerous predisposing factors. We describe a rare case of SCJ infection due to Staphylococcus aureus in an adult without known underlying predisposing conditions and in which recovery was achieved with medical therapy alone.

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.

Spontaneous sternoclavicular joint infections

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.

[Anterior chest wall examination reviewed]

Anterior chest wall involvement is not infrequently observed within inflammatory arthropaties, particularly if one considers seronegative spondyloarthritides and SAPHO syndrome. Physical examination is unreliable and conventional X-rays analysis is an unsatisfactory tool during diagnostic work-up of this region. Scintigraphic techniques yield informations both on the activity and on the anatomical extent of the disease while computerized tomography visualize the elementary lesions, such as erosions, which characterize the process. Moreover, when available, magnetic resonance imaging couple the ability to finely visualize such lesions with the possibility to show early alterations and to characterize the "activity" of the disease, presenting itself as a powerful tool both for diagnosis and follow-up. This review briefly shows the applications of imaging techniques for the evaluation of the anterior chest wall focusing on what has been done in the SAPHO syndrome which can be considered prototypical for this regional involvement since it is the osteo-articular target mainly affected by the disease.

[Primary septic arthritis of the sterno-clavicular joint]

Septic arthritis of the sternoclavicular joint (SCJ) is an uncommon form of arthritis generally occurring in immuno-compromised patients with contiguous or distant foci of infection and central venous catheters. Septic SCJ arthritis in previously healthy subjects is a very rare occurrence requiring a high index of suspicion for the diagnostic assessment. We report here one patient without predisposing factors presenting Staphylococcus aureus SCJ infection.

Tuberculosis of the sternoclavicular joints

From May 1991 to December 1997, we treated 9 patients with tubercular arthritis in 10 sternoclavicular joints. The patients presented with a painful swelling (7 joints), painless swelling (2 joints) and a painless (?) discharging sinus (1 joint) having a mean duration of symptoms of 13 (6-32) months. The diagnosis was made with fine-needle aspiration or open biopsy. In 1 patient debridement of the joint was combined with open biopsy. All patients were initially put on a 4-drug regimen of antitubercular therapy (ATT). 2 joints not responding to closed treatment were surgically debrided after 2-3 months of ATT. Total duration of ATT was 14-18 months. At final follow-up after average 4.5 (1.5-7.5) years, all lesions had healed. 3 patients had mild limitation of shoulder motion, with no pain, and 2 patients had a cosmetically ugly scar at the site of the sinus or biopsy.