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Guerrini S, Bagnacci G, Barile A, La Paglia E, Gentili F, Luzzi L, Giordano N, Fioravanti A, Bellisai F, Cantarini L, Volterrani L, Frediani B, Mazzei MA. Anterior chest wall non-traumatic diseases: a road map for the radiologist. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:43-50. [PMID: 32945278 PMCID: PMC7944680 DOI: 10.23750/abm.v91i8-s.9972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/11/2020] [Indexed: 12/17/2022]
Abstract
The anterior chest wall (AWC) non-traumatic pathologies are largely underestimated, and early detection through imaging is becoming increasingly important. This paper aims to review the major non-traumatic ACW pathologies, with a particular interest in imaging features and differential diagnosis. (www.actabiomedica.it)
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Affiliation(s)
- Susanna Guerrini
- Unit of Diagnostic Imaging, Department of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy.
| | - Giulio Bagnacci
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy.
| | - Antonio Barile
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy.
| | | | - Francesco Gentili
- Section of Radiology, Department of Medicine and Surgery, Azienda Ospedaliera Universitaria di Parma, Parma, Italy.
| | - Luca Luzzi
- Thoracic Surgery Unit, Department of Medical, Surgical and Neuro Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy.
| | - Nicola Giordano
- Scleroderma Unit, Internal Medicine, Department of Medical, Surgical and Neuro Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy.
| | - Antonella Fioravanti
- Unit of Rheumatology, Department of Medical, Surgical and Neuro Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Tuscany, Italy.
| | - Francesca Bellisai
- Unit of Rheumatology, Department of Medical, Surgical and Neuro Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Tuscany, Italy.
| | - Luca Cantarini
- Unit of Rheumatology, Department of Medical, Surgical and Neuro Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Tuscany, Italy.
| | - Luca Volterrani
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy.
| | - Bruno Frediani
- Unit of Rheumatology, Department of Medical, Surgical and Neuro Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Tuscany, Italy.
| | - Maria Antonietta Mazzei
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy.
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Maya GF, Nahmad DL, Or O, Safran O, Beyth S. Friedrich Disease: A Case Report. JBJS Case Connect 2020; 10:e2000027. [PMID: 32865953 DOI: 10.2106/jbjs.cc.20.00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
CASE A 16-year-old girl presented with pain and swelling of the medial edge of the clavicle. She denied previous trauma and was evaluated by multiple physicians for a possible infection or neoplastic lesion. The patient underwent multiple studies and procedures, including blood tests, imaging studies, and biopsy. After 6 months, a diagnosis of osteochondrosis of the medial clavicle was made. After 1 year of observation, the symptoms resolved. CONCLUSIONS The rarity of Friedrich disease and the scarcity of literature may lead to delayed diagnosis of this pathology. Awareness of medical personnel of this condition may facilitate accurate diagnosis.
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Affiliation(s)
- Gabriel Fraind Maya
- 1Department of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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3
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Zaid M, Chavez MR, Carrasco AE, Zimel MN, Zhang AL, Horvai AE, Link TM, O'Donnell RJ. Cutibacterium (formerly Propionibacterium) acnes clavicular infection. J Bone Jt Infect 2019; 4:40-49. [PMID: 30755847 PMCID: PMC6367193 DOI: 10.7150/jbji.29153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 10/03/2018] [Indexed: 12/02/2022] Open
Abstract
Cutibacterium (formerly Propionibacterium) acnes13, 16 is a slow growing, gram-positive bacteria that is naturally found in higher concentrations as skin flora on the chest and back, as well as in other areas with greater numbers of hair follicles.25, 37 Most of the reported cases of C. acnes shoulder girdle infection follow arthroplasty surgery,18, 20, 26, 27, 32, 35 which then often requires debridement, administration of intravenous antibiotics, and surgical revision of the implanted device.12, 15, 21, 28-30 In a recent study, 56% of 193 shoulder revisions had a positive culture, 70% of which grew C. acnes.30 Despite the relatively common presumed association of C. acnes humeral osteomyelitis with prosthetic infection, infection of the scapula or clavicle secondary to C. acnes is rare.4, 23, 36 Osteomyelitis of the clavicle involving any organism is also an uncommon event that can arise spontaneously via presumed hematogenous spread, or secondary to open fractures or internal fixation.6, 33 The most commonly found organism in clavicular osteomyelitis is Staphylococcus aureus.9 We here report two cases of clavicular infection secondary to C. acnes that were not associated with implants.
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Affiliation(s)
- Musa Zaid
- University of California San Francisco, Department of Orthopaedic Surgery
| | - Madisyn R Chavez
- University of California San Francisco, Department of Orthopaedic Surgery
| | | | - Melissa N Zimel
- University of California San Francisco, Department of Orthopaedic Surgery
| | - Alan L Zhang
- University of California San Francisco, Department of Orthopaedic Surgery
| | - Andrew E Horvai
- University of California San Francisco, Department of Orthopaedic Surgery
| | - Thomas M Link
- University of California San Francisco, Department of Orthopaedic Surgery
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4
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Dhawan R, Singh RA, Tins B, Hay SM. Sternoclavicular joint. Shoulder Elbow 2018; 10:296-305. [PMID: 30214497 PMCID: PMC6134528 DOI: 10.1177/1758573218756880] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/14/2017] [Accepted: 12/31/2017] [Indexed: 12/16/2022]
Abstract
The sternoclavicular joint is a saddle shaped, synovial joint and is the only skeletal articulation between the axial skeleton and the upper limb. Here, a reviewis provided of the anatomy, biomechanics, traumatic and atraumatic conditions, and management options for the various conditions described.
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Affiliation(s)
- Rohit Dhawan
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Gobowen, Oswestry, UK,Rohit Dhawan, Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Gobowen, Oswestry, SY10 7AG, UK.
| | - Rohit Amol Singh
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Gobowen, Oswestry, UK
| | - Bernhard Tins
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Gobowen, Oswestry, UK
| | - Stuart M. Hay
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Gobowen, Oswestry, UK,Royal Shrewsbury Hospital, Shrewsbury, Shropshire, UK
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5
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Edwin J, Ahmed S, Verma S, Tytherleigh-Strong G, Karuppaiah K, Sinha J. Swellings of the sternoclavicular joint: review of traumatic and non-traumatic pathologies. EFORT Open Rev 2018; 3:471-484. [PMID: 30237905 PMCID: PMC6134883 DOI: 10.1302/2058-5241.3.170078] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The sternoclavicular joint (SCJ) is an integral part of the shoulder girdle that connects the upper limb to the axial skeleton. Swelling of the SCJ is commonly due to trauma, degeneration, infections and other disease processes that affect synovial joints. This review also focuses on uncommon conditions that could affect the SCJ, including SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome, Friedrich’s disease and Tietze syndrome. The scope of this review is limited to the analysis of the current evidence on the various conditions affecting the SCJ and also to provide an algorithm to manage these conditions.
Cite this article: EFORT Open Rev 2018;3:471-484. DOI: 10.1302/2058-5241.3.170078
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Affiliation(s)
| | - Shahbaz Ahmed
- Pulvertaft Hand Centre, Royal Derby Hospital, Derby, UK
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6
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Toodayan N. A convenient "inconvenience": The eponymous legacy of Sir William Richard Gowers (1845-1915). JOURNAL OF THE HISTORY OF THE NEUROSCIENCES 2017; 26:50-82. [PMID: 26666300 DOI: 10.1080/0964704x.2015.1116280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A century since his passing, the legacy of the great Victorian clinical neurologist, Sir William Richard Gowers (1845-1915), remains traceable to students and practitioners of medicine worldwide through eponymous medical terms named in his honor. Popular designations like "Gowers' sign" continue to lead curious minds to learn more about the pioneering neurologist's lifework and influence, and yet Gowers himself was not fond of medical eponyms. Memorably remarking that eponyms were an educational "inconvenience" in medicine, Gowers was apt to disfavor the system in the very same lecture in which he reportedly first referred to the spinal cord fasciculus that later took his name. This article will examine Gowers' own use of eponyms alongside the eponymous medical terms named for him, and, in the process, will show how Gowers' "inconvenience" may be of great service to the historically inclined modern clinician today.
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Affiliation(s)
- Nadeem Toodayan
- a University of Queensland School of Medicine , Brisbane , Australia
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8
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Akhtar MN, Agarwal S, Athar R. Clinico-radiological Approach to a Rare Case of Early Clavicle Tuberculosis: A Case Discussion Based Review of Differential Diagnosis. J Clin Diagn Res 2015; 9:RE01-5. [PMID: 26266175 DOI: 10.7860/jcdr/2015/11971.6079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 04/28/2015] [Indexed: 11/24/2022]
Abstract
A patient of 41 years of age presented with insidious onset atraumatic swelling arising from medial end of right clavicle with apparently normal radiograph. Initial computed tomography ascribed it to benign bony pathology requiring no specific treatment but patient did not respond to symptomatic management. FNAC done elsewhere was inconclusive, with no bacteria on Gram's staining and negative bacterial culture and AFB smear examinations. Patient had possible exposure to tuberculosis and Mantoux skin test done which showed significant induration. Possible differential diagnoses related to clavicle including infective, neoplastic, rheumatological, degenerative and idiopathic conditions considered. Magnetic resonance imaging (MRI) showed focal periosteal reaction with marrow signal changes with sparing of sternoclavicular joint. Correlation between patient's history, clinical findings and investigations done and diagnosis of isolated clavicle tuberculosis was made. Patient showed good response to anti-tubercular chemotherapy. Repeat MRI showed resolution of initial imaging findings. At the end of 2 years patient was completely symptom free.
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Affiliation(s)
- Mohammad Nasim Akhtar
- Assistant Professor, Department of Orthopaedics, ESI PGIMSR, ESIC Medical College and ESIC Hospital , The West Bengal University of Health Sciences, Kolkata (W.B.), India
| | - Sharat Agarwal
- Associate Professor, Department of Orthopaedics, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences , Shillong (Meghalaya), India
| | - Rizwan Athar
- Consultant Pathologist, Haji Abdul Majid Memorial Hospital , Hojai (Assam), India
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9
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Pourcho AM, Sellon JL, Smith J. Sonographically guided sternoclavicular joint injection: description of technique and validation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:325-331. [PMID: 25614406 DOI: 10.7863/ultra.34.2.325] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The primary purpose of this investigation was to describe and validate a sonographically guided technique for injecting the sternoclavicular joint (SCJ) using a cadaveric model. METHODS A single experienced operator (J.S.) completed 13 sonographically guided SCJ injections on 7 unembalmed cadaveric specimens (4 male and 3 female) using an out-of-plane, caudad-to-cephalad technique to place 1 mL of diluted blue latex into the joint. Within 72 hours, study coinvestigators dissected each specimen to determine the injectate location. RESULTS All 13 injections accurately placed latex into the SCJ with a predilection for the clavicular side (accuracy, 100%; 95% confidence interval, 73%-100%). Three injections (23%) placed all latex on the clavicular side of the SCJ in the presence of a complete intra-articular disk. Dissection revealed incomplete degenerated disks in the remaining 10 joints. Seven of these injections (54%) clearly placed more than 80% of the latex on the clavicular side, whereas the remaining 3 injections (23%) showed nearly equal latex distribution between the clavicular and sternal sides. No injection resulted in neurovascular injury or extracapsular flow. CONCLUSIONS Sonographically guided SCJ injections can be considered in the diagnosis and management of patients presenting with medial shoulder pain syndromes and, using the technique described herein, have a predilection to target the clavicular portion of the joint. In younger patients with possible complete intra-articular disks or in patients with sternal-side conditions, practitioners should consider confirming sternal-side flow after injection or attempt to specifically target the sternal side of the joint.
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Affiliation(s)
- Adam M Pourcho
- Department of Physical Medicine and Rehabilitation, Mayo Clinic Sports Medicine Center, Mayo Clinic, Rochester, Minnesota USA
| | - Jacob L Sellon
- Department of Physical Medicine and Rehabilitation, Mayo Clinic Sports Medicine Center, Mayo Clinic, Rochester, Minnesota USA
| | - Jay Smith
- Department of Physical Medicine and Rehabilitation, Mayo Clinic Sports Medicine Center, Mayo Clinic, Rochester, Minnesota USA.
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10
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The sternoclavicular joint: can imaging differentiate infection from degenerative change? Skeletal Radiol 2010; 39:551-8. [PMID: 19795121 DOI: 10.1007/s00256-009-0802-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Revised: 09/01/2009] [Accepted: 09/03/2009] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The purpose of this study was to determine if there are imaging and clinical findings that can differentiate a septic sternoclavicular joint from a degenerative one. MATERIALS AND METHODS Search of radiology reports from 2000-2007 revealed 460 subjects with imaging of the sternoclavicular joint, of whom 38 had undergone aspiration or biopsy. The final study group consisted of nine subjects with pathologic proof of sternoclavicular joint infection and ten subjects with pathologic and clinical findings excluding infection consistent with degenerative change. Available ultrasound, computed tomography (CT), and magnetic resonance (MR) images were retrospectively reviewed, and echogenicity, capsular distention, erosions, cysts, hyperemia or enhancement, and intensity of bone marrow signal were recorded. Clinical data were also reviewed. FINDINGS The findings significantly associated with sternoclavicular joint infection included degree and extent of capsular distention. With infection, average joint distention was 14 mm (range 10-20 mm) and extended over the sternum and clavicle in 60% compared to 5 mm (range 3-8 mm) with degeneration only extending over the clavicle. Other findings significantly associated with infection included bone marrow fluid signal on magnetic resonance imaging (MRI), elevated Westergren red blood cell sedimentation rate, and fever. The two findings significantly associated with degeneration were subchondral cysts on CT and female gender. Other imaging and clinical variables showed no significant differences between infection and degenerative change. CONCLUSION The clinical and imaging findings significantly associated with sternoclavicular joint infection included joint capsule distention of 10 mm or greater, extension over both the clavicle and sternum, adjacent fluid signal bone marrow replacement, elevated Westergren red blood cell sedimentation rate, and fever.
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11
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Pathology of the thoracic wall: congenital and acquired. Pediatr Radiol 2010; 40:859-68. [PMID: 20432004 DOI: 10.1007/s00247-010-1604-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Accepted: 01/24/2010] [Indexed: 10/19/2022]
Abstract
This review aims to cover the main congenital and acquired lesions that arise in the thoracic wall of infants and children. Imaging often plays an essential role in the evaluation of symptomatic and asymptomatic thoracic wall abnormalities. The use of appropriate imaging modalities for each condition will be addressed, as well as the range of benign and malignant conditions that can occur.
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12
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Bilateral condensing osteitis of clavicles: differential diagnosis of an unusual case. Rheumatol Int 2010; 32:2921-3. [PMID: 20376667 DOI: 10.1007/s00296-010-1480-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2009] [Accepted: 03/27/2010] [Indexed: 10/19/2022]
Abstract
Condensing osteitis of the clavicle (COC) is a rare disease characterized by sclerosis of the medial end of the clavicle. Brower was the first to coin this term in 1974. Since then many cases have been published in medical journals. All the reported cases are female patients (with the exception of one) in child bearing age. Left clavicle is reported to be predominately afflicted by COC. None of the case is reported from Middle East nor from Indian subcontinent. We report the following case of bilateral COC in young Indian female patient diagnosed in Kingdom of Saudi Arabia.
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13
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Robinson CM, Jenkins PJ, Markham PE, Beggs I. Disorders of the sternoclavicular joint. ACTA ACUST UNITED AC 2008; 90:685-96. [PMID: 18539660 DOI: 10.1302/0301-620x.90b6.20391] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The sternoclavicular joint is vulnerable to the same disease processes as other synovial joints, the most common of which are instability from injury, osteoarthritis, infection and rheumatoid disease. Patients may also present with other conditions, which are unique to the joint, or are manifestations of a systemic disease process. The surgeon should be aware of these possibilities when assessing a patient with a painful, swollen sternoclavicular joint.
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Affiliation(s)
- C M Robinson
- Edinburgh Shoulder Clinic, Royal Infirmary of Edinburgh, Old Dalkeith Road, Edinburgh EH16 4SU, UK.
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14
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Carrera EF, Carvalho RL, Netto NA, Nicolao FA, Pedro FJ. Avascular necrosis of the sternal end of the clavicle: a case report. J Shoulder Elbow Surg 2008; 17:e31-3. [PMID: 18203627 DOI: 10.1016/j.jse.2007.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2006] [Accepted: 08/05/2007] [Indexed: 02/01/2023]
Affiliation(s)
- Eduardo F Carrera
- Division of Hand and Upper Limb Surgery, Department of Orthopedics and Trauma, Federal University of São Paulo Medical School (UNIFESP/EPM), São Paulo, São Paulo, Brazil.
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Docquier PL, Malghem J, Mousny M, Rombouts JJ. Chronic osteomyelitis of clavicle as primary manifestation of SAPHO syndrome in adolescents: report of four cases and long-term evolution. Joint Bone Spine 2006; 73:756-9. [PMID: 17011808 DOI: 10.1016/j.jbspin.2006.01.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2005] [Accepted: 01/30/2006] [Indexed: 10/24/2022]
Abstract
Four cases of chronic osteomyelitis of clavicle as primary manifestation of synovitis, acne, pustulosis, hyperostosis, osteomyelitis (SAPHO) are reported in adolescents. In all cases a typical radiographical evolution had been observed with progressive slow migration of sclerotic area from medial to lateral side of clavicle. Long-term evolution was alternation of remission and exacerbation but none of the patients healed.
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Affiliation(s)
- Pierre-Louis Docquier
- Department of Orthopaedic Surgery, Saint-Luc University Hospital, Cliniques Saint-Luc, Universite Catholique de Louvain, 10, avenue Hippocrate, 1200 Brussels, Belgium.
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Abstract
Other than those resulting from trauma and arthritis, disorders of the clavicle are uncommon. Some nontraumatic disorders are found only in infancy and childhood, such as birth fracture, infantile cortical hyperostosis, congenital pseudarthrosis, cleidocranial dysplasia, and short clavicle syndrome. Other nontraumatic disorders occur in both children and adults; these include anterior subluxation of the sternoclavicular joint, Friedrich's disease, hypertrophic osteitis, chronic multifocal periosteitis and arthropathy, and osteomyelitis. Some nontraumatic clavicular disorders are found only in adults, such as distal osteolysis. Because the description and nomenclature of these disorders arise from several medical disciplines, they often are confusing. Until clear, distinguishing features are described, it is advisable to combine some of the entities. This is especially true of the nonsuppurative inflammatory disorders of the clavicle, which appear to fall under the heading of spondyloarthropathy. Treatment varies by disorder and may include symptomatic and expectant management, drug therapy, and nonsurgical or surgical treatment.
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Affiliation(s)
- Rodney K Beals
- Department of Orthopaedics and Rehabilitation, Oregon Health Sciences University, Portland, OR 97239, USA
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Abstract
The sternoclavicular joint is the diarthrodial articulation between the axial and appendicular skeletons. It is subject to the same disease processes that occur in joints, including degenerative arthritis, rheumatoid arthritis, infection, and subluxation. Most of these conditions present with swelling of the joint, which may be associated with pain and/or tenderness. Plain radiographs can demonstrate changes on both sides of the joint. Because of variations in anatomy, computed tomography scans and magnetic resonance images are often necessary to clarify the pathology. With the exception of acute infection, most conditions can be managed nonsurgically, with joint resection reserved for patients with persistent symptoms.
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18
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Harden SP, Argent JD, Blaquiere RM. Painful sclerosis of the medial end of the clavicle. Clin Radiol 2004; 59:992-9. [PMID: 15488847 DOI: 10.1016/j.crad.2004.04.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2004] [Revised: 04/24/2004] [Accepted: 04/30/2004] [Indexed: 11/20/2022]
Abstract
Pain and swelling of the medial end of the clavicle may be associated with radiographic sclerosis. The commonest causes are osteoarthritis, infection and condensing osteitis of the clavicle. Distinguishing between these clinically and radiologically can be difficult but computed tomography (CT) and magnetic resonance imaging (MRI) are often useful for their differentiation. In this review, the typical imaging features of these conditions are presented with an emphasis on the CT and MRI appearances. These are correlated with clinical features, which together should enable a confident diagnosis to be made.
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Affiliation(s)
- S P Harden
- Department of Radiology, Southampton General Hospital, Southampton, UK.
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Abstract
Symptomatic arthritic involvement of the sternoclavicular joint is relatively uncommon and can be a result of distant trauma, infection, and sternocostoclavicular hyperostosis, post-menopausal arthritis, condensing osteitis of the proximal clavicle, or secondary to an underlying arthropathy. Patients with degenerative osteoarthritis due to trauma most commonly have had either an anterior or posterior dislocation, subluxation, or periarticular fracture. Medical claviculectomy with or without ligamentous stabilization is indicated only in situations of painful primary and secondary rheumatoid arthritis, or in patients with neoplastic lesions. Numerous authors have recommended surgical reconstruction but few have reported series larger than two or three cases. This article reviews a few specific arthropathy conditions about the sternoclavicular joint and discusses their nonoperative and operative management.
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Affiliation(s)
- Jeffrey S Noble
- Northeastern Ohio Universities College of Medicine, 4209 State Route 44, Rootstown, OH 44272, USA
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20
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Abstract
Five middle-aged women presented with unexplained chronic swelling at the medial clavicle. None of the patients recalled a history of trauma and none experienced pain or other symptoms associated with the swelling. In all cases, suspicion of tumor prompted referral to an orthopedic oncologist; two cases were biopsied before referral. Radiological studies demonstrated degenerative changes confined to the medial clavicle in three cases, exophytic overgrowth of the medial clavicle and adjacent manubrium in one case, and bilateral degenerative changes on both sides of the joint in one case. Prolonged follow-up supported the diagnosis of a benign, likely degenerative condition. These cases demonstrate the tendency for a variety of degenerative changes to manifest clinically as swelling at the medial clavicle. Inherent properties of the clavicle may predispose the medial clavicle to such changes. Recognition of this entity may prevent unnecessary testing or surgical biopsy of patients with this condition in the future. A thorough differential diagnosis of swelling at the medial clavicle is also presented.
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Affiliation(s)
- Scott Wein
- Department of Orthopaedics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Affiliation(s)
- Fernando Hiramuro-Shoji
- Department of Orthopaedics, University of Texas Health Science Center at San Antonio, Texas, USA
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22
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Coinde E, David L, Cottalorda J, Allard D, Bost M, Lucht F, Stéphan JL. [Chronic recurrent multifocal osteomyelitis in children: report of 17 cases]. Arch Pediatr 2001; 8:577-83. [PMID: 11446177 DOI: 10.1016/s0929-693x(00)00280-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED Chronic recurrent multifocal osteitis (OCRM) is a rare condition in children, of unknown aetiology, which may be misdiagnosed as osteomyelitis, arthritis or tumour. PATIENTS AND METHODS We present a retrospective multicentric study of 17 patients (five boys and 12 girls) with an average follow-up of 7.5 years (six months-25 years). RESULTS A spectrum of presenting features is possible, ranging from bone lesions alone to lesions combined with arthritis, palmoplantar pustulosis or psoriasis. The diagnosis was delayed from two weeks to five years. Roentgenographic evaluation was often normal at the beginning of the disease or showed nonspecific bone reactions. Radioisotope bone scans assisted in establishing the diagnosis and in identifying lesions that were initially clinically silent. Bone biopsies were performed in seven cases. Histopathological examination showed only mild inflammatory nonspecific changes. Microbiological cultures were always negative. Treatments were different according to the evolution of the disease and the hospital. There was no response to antibiotics in seven patients. The response to nonsteroidal anti-inflammatory agents and steroids was moderate and often transient. Salazopyrine and pamidronate treatment used in two patients allowed a durable remission. We lost sight of four patients, pain persisted in three in spite of treatment, it disappeared in two with treatment, mild pain persisted in five without treatment and remission occurred in three without treatment. CONCLUSION This study clarifies the clinical and radiologic features of chronic recurrent multifocal osteomyelitis. The recognition of this rare entity is often delayed and difficulties in patient management sometimes emerge from its usual protracted course.
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Affiliation(s)
- E Coinde
- Service de pédiatrie, hôpital Edouard-Herriot, Lyon, France
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23
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Jurik AG. Noninflammatory sclerosis of the sternal end of the clavicle: a follow-up study and review of the literature. Skeletal Radiol 1994; 23:373-8. [PMID: 7939838 DOI: 10.1007/bf02416996] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The cases of 14 adult females with swelling, tenderness, and sclerosis of the inferomedial part of the clavicle are presented. They were seen during a 16-year period, suggesting that the condition is rare. In ten patients strain at the sternoclavicular joint seemed to be an etiological factor. Eleven patients were followed for periods of 1-13 years (mean 5 years). The clavicular sclerosis regressed and they all developed signs of osteoarthrosis. Based upon available biopsy results and review of reported cases, it is hypothesized that the radiographic changes are due to osteonecrosis of the medial end of the clavicle with subsequent development of osteoarthrosis.
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Affiliation(s)
- A G Jurik
- Department of Diagnostic Radiology, Municipal Hospital, University of Aarhus, Denmark
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24
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Apter S, Hertz M, Salai M, Nerubai J, Bubis JJ. Post-traumatic reactive and resorptive lesions of the medial end of the clavicle. Clin Imaging 1992; 16:40-2. [PMID: 1540862 DOI: 10.1016/0899-7071(92)90089-r] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Three soldiers presented with a painful swelling of the sternoclavicular area. Computed tomography (CT) studies showed sclerosis as well as lysis of the medial end of the clavicle with adjacent soft-tissue swelling. Bone biopsy revealed new bone formation and inflammatory reaction; cultures were negative, no tumor cells were found. The patients recovered after antibiotic treatment. Although the CT findings cannot completely rule out a malignant lesion, these changes in the medial end of the clavicle in young people may suggest trauma as the etiology.
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Affiliation(s)
- S Apter
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel
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25
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Abdelwahab IF, Hermann G, Ramos R, Klein MJ, Kenan S, Lewis MM. Case report 623. Osteitis condensans of the left clavicle (OCC). Skeletal Radiol 1990; 19:387-9. [PMID: 2377910 DOI: 10.1007/bf00193100] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A case of OCC in a 35-year-old woman is presented. Proof was obtained by open biopsy. This rare entity is benign and its etiology is still obscure. No definite association with osteitis pubis or osteitis condensans ilii has been reported. The involvement of the clavicle is invariably unilateral. The clinical and radiographic characteristics of this benign condition have been discussed and the differential diagnosis has been considered. Consideration should be given to the concept that if the imaging features are characteristic, as in this case, biopsy may not be necessary.
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Affiliation(s)
- I F Abdelwahab
- Department of Radiology, Mount Sinai Medical Center, City University, New York, New York 10029-6574
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26
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Eftekhari F, Jaffe N, Schwegel D, Ayala A. Inflammatory metachronous hyperostosis of the clavicle and femur in children. Report of two cases, one with long-term follow-up. Skeletal Radiol 1989; 18:9-14. [PMID: 2711216 DOI: 10.1007/bf00366762] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Two preteenage girls developed painful swelling of the left clavicle. This was followed by painful swelling of the femur, 7 months later in one girl and 8 years later in the other. Radiographic studies showed a predominantly sclerotic process in one patient and destruction associated with cortical thickening in the other. The patients received analgesic medications only, followed by gradual healing with cortical and medullary sclerosis. Long-term follow-up suggests that the condition is self-limited and that, with or without treatment, the bones eventually return to normal. Although the etiology of the lesions remains unknown, the radiographic features suggest an inflammatory reaction.
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Affiliation(s)
- F Eftekhari
- Department of Radiology, University of Texas M.D. Anderson Cancer Center, Houston
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27
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Christensen PB, Christensen I. A case of Friedrich's disease of the clavicle. ACTA ORTHOPAEDICA SCANDINAVICA 1987; 58:585-6. [PMID: 3425292 DOI: 10.3109/17453678709146405] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Friedrich's disease is an aseptic osteonecrosis of the medial end of the clavicle. It is a rare condition that can be confused with osteomyelitis, arthritis, or tumor. Because it often resolves spontaneously, a correct diagnosis will save the patient from unnecessary treatment.
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Affiliation(s)
- P B Christensen
- Department of Orthopedics, Central Hospital, Esbjerg, Denmark
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28
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Abstract
The clinical and radiological features of four patients with inter-sterno-costo-clavicular ossification are described. The process was associated with established seronegative spondyloarthropathy in three cases of whom four had long standing psoriasis, the other having ankylosing spondylitis. In the fourth case no associated arthropathy was present. A review of the literature is presented.
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29
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Hamilton-Wood C, Hollingworth P, Dieppe P, Ackroyd C, Watt I. The painful swollen sterno-clavicular joint. Br J Radiol 1985; 58:941-5. [PMID: 3842310 DOI: 10.1259/0007-1285-58-694-941] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Thirteen patients with isolated pain and swelling of a sterno-clavicular clavicular joint have been reviewed. Three groups were identified. Group 1 comprised four patients, all of whom had a short history of less than six weeks and suffered a pyarthrosis or malignant disease; group 2, four patients who were shown to have features of condensing osteitis of the clavicle (Cone et al, 1983); and group 3, five patients, had degenerative arthritis of a sterno-clavicular joint. The only difference between groups 2 and 3 were that patients in group 3 had a rather longer history, both articular surfaces were involved and showed a possible increase in the incidence of degenerative joint disease elsewhere. It is suggested that condensing osteitis is but a part of a spectrum of degenerative disease of the sterno-clavicular joints, akin to discogenic vertebral body sclerosis (McCarthy & Dorfman, 1982).
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30
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Franquet T, Lecumberri F, Rivas A, Inaraja L, Idoate MA. Condensing osteitis of the clavicle. Report of two new cases. Skeletal Radiol 1985; 14:184-7. [PMID: 4059936 DOI: 10.1007/bf00355559] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Two cases of condensing osteitis of the clavicle are reported in which plain films, computed tomography, scanning, and histologic findings established the diagnosis of this rare entity.
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31
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Abstract
Five adult females with swelling, tenderness and similar sclerotic changes of the sternal end of the clavicle are presented. They were recognised during a 10-year period, suggesting that the condition is rare and may be misdiagnosed. In three patients strain of the sternoclavicular joint seemed to be an aetiological factor.
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