Sternoclavicular joint arthritis

Yood, Robert A.; Goldenberg, Don L.

doi:10.1002/art.1780230215

Cited by 125 publications

(86 citation statements)

References 64 publications

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“…4,5 It often is overlooked and has an insidious onset. [5][6][7] Diabetes, rheumatoid arthritis, intravenous drug use, subclavian vein catheter placement, and other illnesses are risk factors for infection of the SC joint, but its presence in a healthy individual is rarely reported.…”

Section: Discussionmentioning

confidence: 99%

“…Fever is present in 65% cases, and the patient is likely to complain of chest or shoulder pain. 4 Approximately 56% of patients with an infection of the SC joint will be found to have a leukocytosis on complete blood count, and 62% will have positive blood cultures. 5 This information helps to support a presumptive diagnosis of septic arthritis of the SC joint and may prompt further diagnostic testing.…”

Section: Discussionmentioning

confidence: 99%

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Septic Arthritis of the Sternoclavicular Joint

Womack

2012

The Journal of the American Board of Family Medicine

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Septic arthritis is a medical emergency that requires immediate action to prevent significant morbidity and mortality. The sternoclavicular joint may have a more insidious onset than septic arthritis at other sites. A high index of suspicion and judicious use of laboratory and radiologic evaluation can help solidify this diagnosis. The sternoclavicular joint is likely to become infected in the immunocompromised patient or the patient who uses intravenous drugs, but sternoclavicular joint arthritis in the former is uncommon. This case series describes the course of 2 immunocompetent patients who were treated conservatively for septic arthritis of the sternoclavicular joint. Case 1A 50-year-old man presented to his primary care physician with a 1-week history of nausea, vomiting, and diarrhea. His medical history was significant for 1 episode of pseudo-gout. He had no chronic medical illnesses. He was noted to have a heart rate of 60 beats per minute and a blood pressure of 94/58 mm Hg. His heart rate increased to 72 beats per minute while seated. He had presumed gastroenteritis. He was given 2 L intravenous 0.9% normal saline in the outpatient setting, with an increase in blood pressure to 100/68 mm Hg. He was seen 2 days later and was beginning to feel better but had a new complaint of tenderness at the left sternum. The patient began a 5-day course of prednisone. Blood was collected at this time. The next day, blood analysis revealed a critical laboratory value for creatine phosphokinase level of 9005 U/L and an erythrocyte sedimentation rate of 120 mm/hour. The patient was asked to go to the hospital to receive further evaluation. At the time of admission, he continued to complain of left clavicular pain, and the course of prednisone failed to provide any pain relief. The patient denied any current fevers or chills. He was afebrile, and examination revealed a swollen and tender left sternoclavicular (SC) joint. The prostate was normal in size and texture and was not tender during palpation. Laboratory analysis showed a white blood cell count of 19.3 thousand/microliter, with 92% segmented neutrophils and no bands (Table 1). Urinalysis was significant for blood and leukocyte esterase. Blood and urine cultures were obtained. A radiograph of the clavicle was normal. The patient was started on intravenous fluids for the elevated creatine phosphokinase level. Ceftriaxone (1 g intravenous daily) was started for the leukocytosis, pyuria, and history of fever. On hospital day 1, blood and urine cultures yielded Gram-negative bacilli that were later identified as Escherichia coli. It was believed that the E. coli bacteremia seeded the SC joint, leading to septic arthritis. A computed tomography (CT) scan of the sternum was performed to assist with diagnosis and showed no fluid in the SC joint and no sign of bony erosion or sclerosis at the manubrium or medial end of the clavicle. The antibiotic was changed to intravenous ciprofloxacin for better tissue penetration of the urinary tract because the prostate was a concer...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Septic Arthritis of the Sternoclavicular Joint

Womack

2012

The Journal of the American Board of Family Medicine

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“…The sternoclavicular joint is a true synovial lined articulation composed of the inferior portion of the medial head of the clavicle, an indentation in the upper outer portion of the sternum, and the cartilage of the first rib [Yood and Goldenberg, 1980]. The joint is divided into two compartments which in nearly all people is separated by an intra-articular disc.…”

Section: Pathophysiologymentioning

confidence: 99%

“…The articular capsule surrounding the sternoclavicular joint is reinforced anteriorly and posteriorly by ligaments as well as superiorly by the interclavicular ligament. The costoclavicular ligaments extend from the cartilage of the first ribs to the clavicles and are each separated into an anterior and posterior sheet by a bursa [Yood and Goldenberg, 1980]. Surrounding structures like the sternomanubrial joint form a symphysis rather than a true synovium and the costochondral joints form synchondroses [Katz et al 1989].…”

Section: Pathophysiologymentioning

confidence: 99%

“…As discussed earlier, condensing osteitis of the clavicle is a benign disorder thought to be a mechanical phenomenon [Lissens et al 1990;Sartoris et al 1986;Yood and Goldenberg, 1980]. Changes are restricted to the medial portion of the clavicle with sparing of the sternoclavicular joint [Dihlmann et al 1997;Tait et al 1994;Yood and Goldenberg, 1980]. Differentiating SCCH from the seronegative spondyloarthropathies may be challenging at any stage of the illness since this group of arthritides may involve the joints of the sternoclavicular area and distinguishing features may not appear for years after the onset of inflammation.…”

Section: Differential Diagnosismentioning

confidence: 99%

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Sternocostoclavicular Hyperostosis: A Review

Carroll¹

2011

Therapeutic Advances in Musculoskeletal

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Sternocostoclavicular hyperostosis (SCCH) is a chronic inflammatory disorder which presents with erythema, swelling, and pain of the sternoclavicular joint. Approximately one half of patients have acne or pustular lesions with the best described association being with palmoplantar pustulosis (PPP). Extrasternal articular disease occurs in about a quarter of patients. The inflammatory process spans several years and has periods of exacerbation followed by remission. The histologic picture demonstrates a sterile osteomyelitis of the sternum and medial end of the clavicle. The diagnosis of SCCH is confirmed radiographically by hyperostosis and sclerosis of the sternum with involvement of the first rib on computed tomography (CT). The focal uptake of radiopharmaceutical on bone scintigraphy called the 'bullhead' sign is highly sensitive of SCCH. Treatment is aimed at easing pain and modifying the inflammatory process. Evidence over the last two decades suggests a role for intravenous bisphosphonates and tumor necrosis factor alpha inhibitors. A low level of awareness of SCCH often leads to a delay in diagnosis. This translates into significant morbidity and brings a psychological burden. Untreated chronic inflammation of the sternoclavicular joint leads to restricted mobility and secondary degenerative joint changes. In the search for a diagnosis, patients often undergo multiple serologic and imaging studies and in the experience of the author are referred to multiple specialists before a correct diagnosis is made. Greater awareness of SCCH is needed to prevent the irreversible physical and psychological impairments associated with the disease.

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Disseminated Brucellosis Initially Seen as Sternoclavicular Arthropathy

Lam¹

1982

Arch Intern Med

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Sternoclavicular joint arthritis

Cited by 125 publications

References 64 publications

Septic Arthritis of the Sternoclavicular Joint

Septic Arthritis of the Sternoclavicular Joint

Sternocostoclavicular Hyperostosis: A Review

Disseminated Brucellosis Initially Seen as Sternoclavicular Arthropathy

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