Primary pyogenic arthritis of sterno-clavicular joint.
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Adult↗
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Traumatic lateral scapular displacement: an expanded spectrum of associated neurovascular injury.
The clinical entity of "scapulothoracic dissociation" has been reported as an uncommon but devastating shoulder girdle disruption. All previously identified closed injuries have been associated with arterial and brachial plexus compromise; therefore, neurovascular disruption has been presented as an essential diagnostic clinical finding of scapulothoracic dissociation. We have identified and managed four patients who satisfy all the radiographic criteria for scapulothoracic dissociation but who have presented with a spectrum of neurovascular conditions ranging from entirely normal to complete disruption. These patients illustrate a previously unrecognized, or at least unreported, continuum of potential neurovascular compromise associated with disruption of the scapulothoracic articulation. An expanded and more descriptive classification scheme for "traumatic lateral scapular displacement" is proposed to emphasize the spectrum of possible presentations of this injury.
Adolescent↗
Fractures of the clavicle in the adult. Epidemiology and classification.
From 1988 to 1994 a consecutive series of 1000 fractures of the adult clavicle was treated in the Orthopaedic Trauma Clinic of the Royal Infirmary of Edinburgh. In males, the annual incidence was highest under 20 years of age, decreasing in each subsequent cohort until the seventh decade. In females, the incidence was more constant, but relatively frequent in teenagers and the elderly. In young patients, fractures usually resulted from road-traffic accidents or sport and most were diaphyseal. Fractures in the outer fifth were produced by simple domestic falls and were more common in the elderly. A new classification was developed based on radiological review of the anatomical site and the extent of displacement, comminution and articular extension. There were satisfactory levels of inter- and intraobserver variation for reliability and reproducibility. Fractures of the medial fifth (type 1), undisplaced diaphyseal fractures (type 2A) and fractures of the outer fifth (type 3A) usually had a benign prognosis. The incidence of complications of union was higher in displaced diaphyseal (type 2B) and displaced outer-fifth (type 3B) fractures. In addition to displacement, the extent of comminution in type-2B fractures was a risk factor for delayed and nonunion.
Accidental Falls↗
The role of computed tomography in diseases of the musculoskeletal system.
Computed tomography has added another dimension to the evaluation of musculoskeletal disease. The ability to discern subtle differences in tissue densities and the capability of viewing structures in the axial plane has greatly aided the resolution between normal and pathologic tissue and the appreciation of the anatomic relation between normal and pathologic structures. This paper deals with the application of CT in the evaluation of neoplastic, inflammatory, traumatic, metabolic, and congenital diseases of the musculoskeletal system.
Ankle Injuries↗
[Retrosternal luxation of the clavicle. Apropos of 4 cases surgically treated using a temporary screwed anterior plate and review of the literature].
The authors report 4 new cases of retrosternal dislocation of the clavicle operated by capsular and ligament restoration, and temporary stabilization by anterior plating. The 4 patients were men with a mean age of 17.5 years. The lesion was caused by a sports injury (football, rugby) in 3 out of 4 cases and was related to an indirect mechanism. Clinical examination allowed the diagnosis, was related to based on painful palpation of a dip over the joint, supported by radiology and computed tomography. CT did not reveal the epiphyseal separation present in two cases. Complications were frequent: 1 case of tracheal compression, 2 cases of temporary paresthesia of the upper limb, 2 cases of venous compression with one case of subclavian and medial jugularis venous thrombosis, 1 hemopneumothorax. Surgical reduction was performed in all 4 cases after 2 failures of attempted orthopedic treatment under general anesthesia. All patients recovered a full range of movement, a painless shoulder and no recurrence has been observed. All complications resolved after reduction. Venous thrombosis responded favourably after 6 months of anticoagulant therapy. One plate breakage was observed with no clinical implications. On the basis of an extensive review of the literature, the authors discuss the epidemiology, pathology and the importance of associated injuries, which are frequent and sometimes serious, justifying urgent reduction. Computed tomography is the most useful radiologic modality, both for diagnosis and for investigation of complications. Orthopedic treatment must be attempted first (especially in children) according to a well systematized technique. One third of attempts fail, and cases of delayed diagnosis and serious vascular complications, then require surgical treatment. The costoclavicular ligament is repaired either by Burrows's ligamentoplasty or by bone suture; the clavicle is stabilized by bone suture or by anterior plating. The authors do not advocate either joint fixation by Kirschner wire, or resection of the medial end of the clavicle.
Accidents, Traffic↗
Bone and joint infection in a renal unit.
Between 1980 and 1984 nine adult patients in the renal unit of Guy's Hospital developed bone and joint infection. The commonest site of infection was the spine. In this series two patients died, a mortality of 22%. The purpose of this paper is to illustrate the pitfalls in the diagnosis and management of bone and joint infection in patients with renal failure and renal transplants.
Abscess↗
Sternocostal joints, low back pain and lumbar discopathy.
New interrelations between the distensions of the 5th, 6th and 7th ribs and low back pain were studied in two groups of patients: 1) one hundred out-patients with prevalent pseudoradicular symptomatology and 2) fifty patients hospitalised for graphically verified (CT, PMG) lumbar disc herniation and pronounced radicular symptomatology. We have introduced some measurements to document asymmetrical holding of the body and limbs: the distance between the sternoclavicular joint-spina iliaca ant. sup. and the distance between the acromion and spina iliaca post. sup. We found that in the distension (blockade) of the 5th rib, constant spasms are present in m. abdominis obliquus ext., in the most lateral part of the adductors and in the most medial part of the great gluteal muscle. In 6th rib distension, spasms in the external part of the m. rectus abdominis, and in the mediolateral fascicles of thigh adductors and in the external part of m. glutaeus max. could be palpated. In 7th sternocostal distension there are spasms in the most medial parts of m. rectus abdominis, and of thigh adductors and m. glutaeus medius of the same side. After mobilization, statistically significant improvement of body asymmetry (p less than 0.01), improvement of anteflection, bending to the side, Laségue's and Patric's phenomena were found. Surgery was indispensable only in 6% of our patients suffering from severe lumbar disc hernianion (in 3 out of 50). The CT appearance of the prolapse remained unaltered even after clinical remission. There were some changes before and after mobilization in the CT picture of sternocostal joints. The importance of strengthening of the great pectoral muscles--in which preexistent relative weakness was found--is stressed. The beneficial effect of mobilization of the respective sternocostal blockade on the pain syndrome, body asymmetry and mobility is described.
Adolescent↗
The painful swollen sterno-clavicular joint.
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).
Adult↗
Pustulotic arthro-osteitis. A report of two cases.
Pustulosis palmoplantaris (PPP) has been reported to be associated with characteristic inflammatory bone and joint lesions predominantly in the sterno-costoclavicular region and the spine. We have observed 2 patients with findings in accordance with previous reports.
Arthritis↗
Technical note: the design of a stereotactic frame for direct MRI-anatomical correlation of the brachial plexus.
The purpose of this study was to identify optimal magnetic resonance imaging (MRI) conditions to visualize discrete alterations of brachial plexus components, as part of a biomechanical study of minor nerve compression syndromes. A method was developed allowing direct comparison between the MRI image and the subsequently obtained matching anatomic section of the same specimen. We designed a stereotactic frame to obtain the precise orientation of the MRI plane with reference to the specimen and adapted a vertical band saw for multiplanar sectioning of cadaveric specimens. Two cadaveric upper quadrants were examined by MRI (TR 450 ms, TE 13 ms, pixel matrix 512 x 512 and FOV 23-26 cm) and anatomical slices were produced. One specimen was sectioned axially, while the second specimen was sectioned in an oblique plane corresponding to the natural longitudinal axis of the upper part of the brachial plexus. MR images and the corresponding slices exhibited a strong correlation. This correlation was checked by using vitamin A pearls as landmarks. MR images revealed more detail after the correlating anatomical slices were analyzed. The present study shows that the method is suited for direct MRI-anatomic comparison of the brachial plexus and is also proposed for application to other topographical regions.
Acromioclavicular Joint↗
[Sterno-costo-clavicular hyperostosis (author's transl)].
A case is described in which bilateral subclavian vein occlusion was caused by fusiform expansion of the clavicle with hyperostosis, ankylosis of the sterno-clavicular joint, widening and thickening of the sternum and ossification of the costal cartilage of the first ribs. Histologically this proved to be due to an hyperostotic spongiosclerosis.
Ankylosis↗
Surgical treatment of chronic dislocation of the sterno-clavicular joint.
The costo-clavicular ligament is always ruptured in dislocation at the sterno-clavicular joint. Anterior, superior or posterior displacement of the medial end of the clavicle may occur. Acute dislocation usually responds to conservative treatment and operation is seldom required. Chronic, or recurrent, dislocation may cause pain and disability on strenuous activity and necessitate surgical treatment. The operation of tenodesis of the subclavius tendon with capsulorrhaphy described by Burrows (1951) has been adopted. The intraarticular meniscus is often damaged and displaced, and may block reduction; its removal is then necessary. In addition, a threaded Stinmann pin transfixing the joint has been found useful to maintain the stability of reduction. The operation has been performed on five patients, four of whom had excellent results. The fifth patient disrupted the repair in a drinking bout shortly after the operation.
Adult↗
Descending necrotizing mediastinitis with sternocostoclavicular osteomyelitis and partial thoracic empyema: report of a case.
We present herein the case of a 50-year-old woman in whom descending necrotizing mediastinitis originating from an anterior neck abscess spread to the left upper bony thorax, resulting in osteomyelitis of the left sternocostoclavicular articulation and left partial thoracic empyema. Transcervical mediastinal irrigation and drainage was performed with aggressive antibiotic therapy, followed by resection of the left sternocostoclavicular joint and debridement of the anterior mediastinum. The patient had an uneventful postoperative course, and her left arm and shoulder mobility was well preserved.
Abscess↗
A case of abnormal localization of osteomyelitis.
A patient with osteomyelitis and abnormal localization of the changes is presented--left sterno-clavicular joint, the medial parts of the clavicular bone and the first rib, as well as the manubrium sterni. General and target radiography, tomography and chest CT-scan were performed. The reported case is of interest because of the rare localization, the characteristics of the X-ray conduct and the symptomatology in differential and diagnostic aspect.
Clavicle↗
Injuries of the sterno-clavicular joint in backpackers.
Anterior sterno-clavicular dislocation, or fracture dislocation, as a result of carrying a backpack has not previously been described. We describe two cases, and reflect on the factors that may have led to the injuries, noting that the current PLCE (personal load carrying equipment) may also increase the risk of this condition. The condition is one that carries a grading of U8 (unfit for service), and is one that Medical Officers should be aware of, as it has serious implications for a continuing military career.
Adolescent↗
Sternocostoclavicular hyperostosis: its progression and radiological features. A study of 12 cases.
Twelve cases of sternocostoclavicular hyperostosis were followed up over four to 16 years. The patients underwent repeated radiological examinations of the sternocostoclavicular joints and the sternum, and the extrasternal osseous manifestations of the disease were studied to show changes in the radiological features during long term follow up. Five of 12 (41%) patients had extrasternal manifestations. With the exception of one patient extrasternal manifestations were first detected by scintigraphs because they were asymptomatic. With respect to the sternal manifestations the initial radiological diagnosis was made during an acute phase while painful swelling over the sternum and decreased mobility of the shoulders occurred. The radiological examinations showed the signs of a proliferative destructive arthritis in most patients. In contrast with the frequent occurrences of clinical symptoms, the radiological signs of progression take several years to become detectable. There are no specific bacteriological, serological or histological findings. Usually a permanent increase in the erythrocyte sedimentation rates is found. Sternocostoclavicular hyperostosis is a slowly progressing disease, characterised by a chronic aseptic destructive sternoclavicular arthritis with a reactive low turnover sclerosis that begins in a similar way to an enthesopathy and ends after several decades with total ankylosis. The radiological identification of retrosternal proliferation of soft tissue by computed tomography was found to be a valuable criterion for the differential diagnosis from other benign hyperostotic processes of the sternoclavicular region.
Cervical Vertebrae↗
Clinical features of 22 cases with "inter-sterno-costo-clavicular ossification". A new rheumatic syndrome.
We present 22 cases with inter-sterno-costoclavicular ossification. Clinical and pathological findings show that abnormal ossification observed in this situation is due to non-suppurative chronic inflammation of the soft tissues around the sterno-costo-clavicular region such as the costo-clavicular ligament. We have classified X-ray findings into three stages according to the extent of the ossification; localized, generalized, and hyperostotic, and show that the disease progressed in this sequence. A considerable number of the patients showed abnormal X-ray findings in the spine or the sacro-iliac joint. Frequent association of pustulosis palmaris et plantaris was noted in this disease. Most of the cases were treated effectively with anti-inflammatory drugs, but a few cases required surgical resection of the ossified mass with the clavicle or the first rib in order to relieve the severe pain.
Adult↗
Osteoarticular manifestations of pustulosis palmaris et plantaris and of psoriasis: two distinct entities.
OBJECTIVE: To test the hypothesis that pustulosis palmaris et plantaris and psoriatic arthritis (PsA) are two distinct diseases, and that the associated dermatoses are therefore also distinct diseases. METHODS: We prospectively performed clinical, radiological, biological, and bone scan investigations in 23 outpatients with pustolotic arthritis and 23 outpatients with PsA, matched by gender, age (+/- one year) and duration of arthritis (+/- two years). RESULTS: The anterior chest wall, especially the sternocostoclavicular joints, was more frequently involved in pustulotic arthritis than in PsA, both clinically (82% v 43%; p < 0.001) and radiologically (47% v 17%; p < 0.05). Sternocostoclavicular joints generally presented with erosive lesions in PsA, and with large ossifications in pustulotic arthritis. Peripheral joint involvement was mono- or oligoarticular, affecting proximal joints, in pustulotic arthritis (74% v 21%; p < 0.01), and polyarticular, involving small distal joints, in PsA (60% v 0%; p < 10(-4)), in which condition it was also more often erosive (43% v 8%; p < 0.01). The frequency of sacroiliitis and of spine involvement was similar in pustulotic arthritis and PsA. Biology and bone scan did not help distinguish between the two groups. CONCLUSIONS: Pustulotic arthritis and PsA are clinically and radiologically different, therefore pustulosis palmaris et plantaris and psoriasis are most probably distinct dermatological diseases.
Arthritis, Psoriatic↗