Ortho Dx: Swelling Around the Clavicle - Clinical Advisor

Ortho Dx: Swelling Around the Clavicle

Slideshow

  • Image 1. Photographic image of the patient’s clavicle

  • Figure 1. Anteroposterior radiograph of the sternoclavicular joint.

A 50-year-old woman presents to the office with a 1-month history of swelling around the medial clavicle and mild discomfort with shoulder movement. She is alarmed at how prominent her clavicle appears. Physical examination reveals swelling over the sternoclavicular (SC) joint without erythema or warmth (Image 1). She has no pain with horizontal adduction of the arm. Anteroposterior radiograph of the SC joint is obtained (Figure 1).  

The SC joint is a fibrocartilaginous joint that is supported by an articular capsule and anterior/posterior ligaments. The SC joint is synovial-lined and contains a thick intra-articular disc that acts as a buffer between joint surfaces. The SC joint is...

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The SC joint is a fibrocartilaginous joint that is supported by an articular capsule and anterior/posterior ligaments. The SC joint is synovial-lined and contains a thick intra-articular disc that acts as a buffer between joint surfaces. The SC joint is a diarthrodial joint that allows for a wide range of movement with clavicle and shoulder motion.1,2

Several disorders can occur at the SC joint including osteoarthritis and synovitis, joint sprain, dislocation, and septic arthritis.2,3 As the SC joint is superficial, swelling can be easily seen on physical examination.  SC joint swelling, most commonly from arthritis, can occur in a large area around the joint, which may make the clavicle on the affected side appear more prominent. More often than not, asymptomatic swelling is the presenting complaint of patients with SC joint arthritis. SC joint sprains and dislocations usually are the result of a high-energy injury such as a motor vehicle accident or a sports-related injury.1,2

Standard radiographs are recommended as initial imaging for nontraumatic SC joint swelling and pain. For traumatic injuries, computed tomography is recommended to evaluate the SC joint in multiple planes. Posterior dislocation is a serious condition that may be missed on plain radiographs. Posterior dislocation can compress on the mediastinum causing venous congestion, cough, dysphagia, and a feeling of choking.1,2

Treatment for SC joint swelling due to arthritis includes observation, oral nonsteroidal anti-inflammatory drugs, and ice. Injections are rarely performed in the SC joint due to risk of neurovascular injury.1,2

Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor in chief of the Journal of Orthopedics for Physician Assistants.

References

1. Yood RA, Goldenberg DL. Sternoclavicular joint arthritis. Arthritis Rheum. 1980;23(2):232-239.

2. Robinson CM, Jenkins PJ, Markham PE, Beggs I. Disorders of the sternoclavicular joint. J Bone Joint Surg Br. 2008;90(6):685-696.

3. Edwin J, Ahmed S, Verma S, et al. Swellings of the sternoclavicular joint: review of traumatic and non-traumatic pathologies. EFORT Open Rev. 2018;3(8):471-484.

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