19.1
Introduction
The sternocostoclavicular (SCC) region can be involved by all kinds of musculo- skeletal disorders. Apart from the disorders dealt with in Chapters 10–18 the fol- lowing disorders have been observed.
19.2
Metabolic Disorders
Osteoarthropathy in primary and secondary hyperparathyroidism can involve the sternoclavicular region. Subperiosteal bone resorption and sclerosis, particularly along the inferior margin of the clavicle, result in widening and irregularity of the sternoclavicular joint. The changes are related predominantly to trabecular de- struction beneath cartilage surfaces, substitutive fibrosis and new bone formation
Contents
19.1 Introduction . . . 245
19.2 Metabolic Disorders . . . 245
19.3 Amyloidosis . . . 246
19.4 Synovial Osteochondromatosis . . . 246
19.5 Postoperative Disorders . . . 247
19.6 Spontaneous Atraumatic Subluxation . . . 247
19.7 Other Disorders . . . 247
19.8 Conclusions . . . 250
References . . . 250
19 Miscellaneous Disorders
Anne Grethe Jurik
Anne Grethe Jurik
(Fig. 19.1) [8]. Careful analysis of the sternoclavicular region on frontal chest film will usually disclose manifest changes. A radiographic diagnosis of hyperparathy- roidism can thus be obtained from an otherwise negative chest study [13]. Also tumour-like calcific deposition may occur in the SCC region as part of hyperpara- thyroidism [7].
19.3
Amyloidosis
Amyloid deposition is an important complication of long-term haemodialysis. It may be deposited in and around synovia, ligaments, tendons and bones, and may involve the sternoclavicular region [2]. The main radiographic features are periar- ticular soft tissue swelling, subchondral cysts and articular erosion. This appear- ance may simulate arthritis or infection [2]. Bone scintigraphy can sometimes be used to differentiate amyloidosis from infection because joint destruction due to amyloid deposition may fail to take up tracer.
19.4
Synovial Osteochondromatosis
Synovial osteochondromatosis is a disorder characterised by hyperplastic prolifer- ation of connective tissue in the synovial membrane with formation of metaplastic cartilage. It occurs mainly as a monarticular involvement of large joints, but can occur corresponding to the sternoclavicular joint even in children [14].
Fig. 19.1 Hyperparathyroidism. AP radiograph of the sternoclavicular joints in a 25-year- old woman with secondary hyperparathyroidism. There are irregular joint facets with mani- fest osseous resorption in the medial part of the clavicles (arrows). The joint space thereby looks widened
Chapter 19 Miscellaneous Disorders
19.5
Postoperative Disorders
Sternotomy for heart and vessel surgery may imply several postoperative changes or complications. Postoperative infection can be a serious complication with ab- scess formation and fistula. In a later stage pseudoarthrosis may be seen due to inadequate healing with widening of the sternotomy cleft and smoothing of the bone surface [12]. Occasionally broken cerclage wires cause pain and can be seen at radiography [11]. Osseous resorption around fixation material can also occur due to metalosis.
19.6
Spontaneous Atraumatic Subluxation
Spontaneous atraumatic subluxation of the sternoclavicular joint is a relatively rare problem, occurring most commonly in teenagers and young adults who have gen- eral laxity. The subluxation occurs either during routine overhead activities or dur- ing overhead sports activities [9]. Spontaneous subluxation can also occur as part of a degenerative process or non-infectious subacute arthritis (Fig. 19.2) [10].
19.7
Other Disorders
Pagets’ disease occurs rarely in the SCC region. Polyostotic Pagets’ disease may involve the manubrium and sternal body [3], and monostotic lesions can be seen in the clavicle. It presents as an enlarged and irregular dense osseous lesion. The definite diagnosis is usually based on typical histological features of active osteo- clast resorption and osteoblast production.
Osteopetrosis, also named Albers Schoenberg disease, and other disorders in- volving the bone marrow may involve the SCC region (Fig. 19.3). Osteopetrosis represents a heterogeneous group of disorders characterised by an increase in bone density due to a defect in osteoclastic bone resorption [1].
Avascular necrosis or aseptic necrosis of the clavicular head (Friedrich’s disease)
has been reported [5] and may also occur corresponding to the sternum in dis-
orders disposing to necrosis, such as sickle cell disease [6]. Also Langerhans’ cell
histiocytosis has been reported in the sternum [4].
Anne Grethe Jurik
Fig. 19.2 Spontaneous atraumatic subluxation of the sternoclavicular joint in a 62-year-old woman with a sudden swelling at the right sternoclavicular joint. a Axial CT slices show the clavicular joint facet displaced anteriorly (arrow) in relation to the sternum. b Coronal reconstruction shows definite signs of osteoarthritis in the form of osteophytes (arrows) and subchondral cysts
Chapter 19 Miscellaneous Disorders
Fig. 19.3 Osteopetrosis. Frontal tomography of a 20-year-old woman with inherent osteo- petrosis. There is a homogeneous increased osseous density of the sternum and the medial part of the clavicles
Anne Grethe Jurik
19.8
Conclusions
Many different disorders may involve the SCC region and have to be taken into consideration in patients with SCC symptoms or abnormal radiological findings.
References
1. Balemans W, Van Wesenbeeck L, Van Hul W (2005) A clinical and molecular overview of the human osteopetroses. Calcif Tissue Int 77:263–274
2. Cameron EW, Resnik CS, Light PD, Sun CC (1997) Hemodialysis-related amyloidosis of the sternoclavicular joint. Skeletal Radiol 26:428–430
3. Dowling K, Hutto RL, Dowling EA (1991) Sternal mass in a patient with Paget’s disease.
Invest Radiol 26:615–619
4. Fazio N, Spaggiari L, Pelosi G, Presicci F, Preda L (2005) Langerhans’ cell histiocytosis.
Lancet 365:598
5. Jurik AG (1994) Noninflammatory sclerosis of the sternal end of the clavicle: a follow- up study and review of the literature. Skeletal Radiol 23:373–378
6. Knight-Madden JM, Sang MM, Ramphel PS (2005) Trap-door sternum in sickle cell disease. J Pediatr 146:845
7. O’Malley BM, Haller JO, Twersky J, Tejani AH (1989) CT appearance of large sterno- clavicular calcific masses in a teenager with chronic renal disease and secondary hyper- parathyroidism, on hemodialysis maintenance. Pediatr Radiol 19:339–340
8. Resnick D, Niwayama G (1976) Subchondral resorption of bone in renal osteodystro- phy. Radiology 118:315–321
9. Rockwood CA Jr, Odor JM (1989) Spontaneous atraumatic anterior subluxation of the sternoclavicular joint. J Bone Joint Surg Am 71:1280–1288
10. Sadr B, Swann M (1979) Spontaneous dislocation of the sterno-clavicular joint. Acta Orthop Scand 50:269–274
11. Shih CM, Su YY, Lin SJ, Shih CC (2005) Failure analysis of explanted sternal wires. Bio- materials 26:2053–2059
12. Templeton PA, Fishman EK (1992) CT evaluation of poststernotomy complications.
Am J Roentgenol 159:45–50
13. Teplick JG, Eftekhari F, Haskin ME (1974) Erosion of the sternal ends of the clavicles. A new sign of primary and secondary hyperparathyroidism. Radiology 113:323–326 14. Vrdoljak J, Irha E (2000) Synovial osteochondromatosis of the sternoclavicular joint.
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