Sternoclavicular arthritis?

[Xue Heng]

Hi, Steve.
The patient was a 48-year-old male with chest wall pain for 2 weeks.
He had no history of trauma or overuse.
The maximum tenderness correponded to bilateral sternoclavicular joint.
And US showed very irregular bony surface with synovitis.
Is the diagnosis Sternoclavicular arthritis?
And is there any differential diagnosis?
Thank you for your patient and detailed answer.

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[Stephen Bird]

It is an unusual appearance.

When I scan the SC joint it looks like an AC joint where you can see the two bone ends and a synovial joint between them.

I would expect to see some bony change at the medial end of the clavicle and also the manubrium of the sternum and some vascularity of the joint space representing synovitis.

Your images don’t look like this and there is a more general area of bony irregularity.

It is not a typical appearance and I think some cross sectional imaging may be required to exclude things like a metastasis or osteomyelitis.

I have attached a recent case I scanned.

There is obvious joint degeneration in this case, but interestingly only minimal vascularity and synovitis. The patient presented with a swelling, but not pain

Steve.

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[Xue Heng]

Thank you, Steve. I will follow up the patient, and advise him for further imaging studies.

[Stephen Bird]

Please let us know what you discover.

Steve.

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