Sternoclavicular Joint Infection

Excerpt

The sternoclavicular joint is a saddle-shaped diarthrodial joint that joins the upper extremity appendicular skeleton to the axial skeleton. The large medial clavicle articulates with the superomedial manubrium and costal cartilage of the first rib, forming a joint with very little bony stability. Within the joint is an intra-articular disc ligament composed of dense fibrous cartilage that provides structural support and prevents medial displacement of the clavicle. The surrounding robust costoclavicular ligament and capsule offers an added layer of support. The primary restraints to anterior and posterior translation of the joint are the anterior and posterior sternoclavicular ligaments. Despite these restrictions, the sternoclavicular joint is actually very mobile and moves more than 30 degrees in the axial and coronal planes while having more than 45 degrees of rotation. Functionally, it is quite similar to other amphiarthroses, such as the sacroiliac joint or pubic symphysis.

Blood supply to the joint comes from the articular branches of the suprascapular and internal thoracic arteries. The nerve to the subclavius muscle and the medial suprascapular nerves provide innervation to the sternoclavicular joint.

Septic arthritis of the sternoclavicular joint is rare and represents less than 1% of all bone and joint infections. A sternoclavicular joint infection is, in the majority of cases, associated with other systemic illnesses and/or general poor health status. Common concurrent issues include diabetes, intravenous drug use, immunosuppression, and rheumatoid arthritis. While rare, prompt diagnosis and treatment are essential to prevent spread into the posteriorly located great vessels, mediastinum, and pleural space.