Sternoclavicular joint osteophytosis: a difficult diagnosis to swallow

Abstract

Unexplained dysphagia requires prompt investigation to rule out a possible underlying malignancy. We describe the case of a 60-year-old man who presented to his family practitioner with a 1-year history of increasing dysphagia with associated pain over the front of his chest. He was referred on to an ear, nose and throat specialist where no obvious laryngeal pathology was found at direct laryngoscopy, but an 'indentation' of the right anterior larynx, which increased with external pressure on the sternoclavicular joint (SCJ), was noted. A subsequent CT scan of his neck demonstrated osteoarthritis of the right SCJ with an abnormally large posterior osteophyte. The patient was subsequently referred on to an orthopaedic surgeon specialising in SCJ surgery and underwent an arthroscopic excision of his right SCJ. Soon after surgery, the patient's dysphagia had settled and his symptoms remain resolved 1 year post surgery.

Keywords: orthopaedic and trauma surgery; osteoarthritis; otolaryngology / ENT.

Figure 1

Axial slices of CT showing large osteophyte extending from posterior medial aspect of right clavicle.

Figure 2

Postoperative CT showing excision of the posterior osteophyte from the medial end of the clavicle.

Figure 3

Three-dimensional volume-rendered CT of right sternoclavicular joint showing excision of the posterior osteophyte from the medial end of the clavicle, viewed from the anterior superior aspect.