Diagnosis and management of sternoclavicular joint infections: a literature review

Abstract

The sternoclavicular joint (SCJ) is anatomically and clinically significant considering its proximity to important neuro-vascular structures like the subclavian vessels and the phrenic nerve. Infections of this joint masquerade multiple disorders, delay diagnosis and spread to the bone and deep tissues. There is no standardized workup and treatment protocol for sternoclavicular joint infections (SCJI) as defined in literature. Here, we review the existing literature to understand the current knowledge of the diagnosis and treatment of SCJI. We searched English publications in PubMed and included clinical trials, case reports, case series, retrospective cohort studies, literature and systematic reviews after excluding non-infectious etiology of SCJ pathologies. There are many risk factors for SCJI, such as immunocompromised status, intravenous drug use, trauma and arthropathies. But a large percentage of patients with disease have none of these risk factors. SCJIs can present with fever, joint swelling, immobility, and rarely with vocal cord palsy or dysphagia. While Staphylococcus aureus causes over 50% of SCJI cases, other pathogens such as Pseudomonas and Mycobacterium are frequently seen. When diagnosed early, the infection can be medically managed with antibiotics or joint aspirations. Most cases of SCJI, however, are diagnosed after extensive spread to soft tissue and bones requiring en-bloc resection with or without a muscle flap. Complications of undertreatment can range from simple abscess formation to mediastinitis, even sepsis. SCJIs are rare but serious infections prompting early detection and interventions. Most cases of SCJI treated adequately show complete resolution in months while retaining maximum functionality. Key features of proper healing include aggressive physiotherapy to prevent adhesive shoulder capsulitis and decreased range of motion.

Medical Management of Septic Arthritis of the Sternoclavicular Joint With Extended-Spectrum Beta-Lactamase-Producing Escherichia coli: A Case Report

“…The abnormalities in the other three patients included joint space widening, presence of a soft tissue shadow, and evidence of osteolysis in the clavicle [ 1 ]. It can take up to 12 days for a CXR to reveal soft tissue swelling [ 18 ]. Our patient's first imaging was a CXR and was negative for any acute findings.…”

“…A retrospective study of 10 patients with SCJ septic arthritis revealed that 2 to 11 radiological tests were needed to establish the diagnosis, and that CT or MRI was needed in all patients [ 18 ]. MRI as the initial diagnostic test had the best sensitivity, and can show changes within one to two days with no diagnostic delay.…”

Mediastinal abscess in an immunocompromised patient which progressed from sternoclavicular joint septic arthritis

“…The antibiotic regimen was changed from ampicillin-sulbactam to amoxicillin-clavulanate on day 15. 1 Her CT on day 20 showed resolution of the extrapleural and mediastinal abscesses, and a decrease in the extent of her sternoclavicular joint abscess. She was discharged on day 22.…”

“…It can spread by direct extension into a neighbouring structure through the space formed by the cervical fascia. 1 Common risk factors include an immunocompromised host, diabetes mellitus, trauma, infection at a distant site and intravenous drug use. 2 We present a case of sternoclavicular joint septic arthritis during regular steroid use, which resulted in mediastinitis through the pretracheal space despite early puncture drainage.…”

Minimally Invasive Surgery for Sternoclavicular Joint Infection with Osteomyelitis, Large Abscesses, and Mediastinitis

“…Sternoclavicular joint infection is a rare form of septic arthritis caused by infectious seeding via the hematogenous route or by direct contiguous spread [ 1 – 3 ]. The infection can spread to surrounding structures via the lymphatic vessels or by direct extension [ 4 , 5 ], causing serious complications, such as osteomyelitis (56%), abscess formation (25%), and mediastinitis (13%) [ 1 ].…”