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Review Article: C. M. Robinson, P. J. Jenkins, P. E. Markham, and I. Beggs Disorders of the sternoclavicular joint J Bone Joint Surg Br 2008; 90-B: 685-696 [Abstract] [Full text] [PDF]

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Superior dislocation of the sternoclavicular joint

Kalum De Silva, Lydia Milnes, Ziad Harb, Quamar Bismil   (11 July 2008)

The role of a chest radiograph in the diagnosis of sternoclavicular joint disorders

Amit SC Bidwai, Dawn Soo and Tim N. Board   (9 July 2008)

Superior dislocation of the sternoclavicular joint 11 July 2008
Kalum De Silva, Senior House Officer Trauma and Orthopaedics Department of Orthopaedics St Georges Hospital, London, Lydia Milnes, Ziad Harb, Quamar Bismil Send letter to journal: Re: Superior dislocation of the sternoclavicular joint kalum_de_silva{at}hotmail.com Kalum De Silva, et al.	Sir, We read with interest Robinson et al's review article on disorders of the sternoclavicular joint. This paper succinctly and logically summarises the plethora of potential injuries and pathologies at the sternoclavicular joint. The section on dislocations is instructive, but for completeness readers of the journal should be aware that superior dislocation (in addition to anterior and posterior) has been reported.¹ K. De Silva, Senior House Officer, Trauma and Orthopaedics, L. Milnes, Z. Harb, Q. Bismil, Department of Orthopaedics, St. George's Hospital, London, UK. 1. Little NJ, Bismil Q, Chipperfield A, Ricketts DM. Superior dislocation of the sternoclavicular joint. J Shoulder Elbow Surg 2008;17:e22-3.
The role of a chest radiograph in the diagnosis of sternoclavicular joint disorders 9 July 2008
Amit SC Bidwai, StR Trauma and Orthopaedics Wrightington, Wigan, Leigh NHS Trust, Dawn Soo and Tim N. Board Send letter to journal: Re: The role of a chest radiograph in the diagnosis of sternoclavicular joint disorders bidwai2000{at}yahoo.co.uk Amit SC Bidwai, et al.	Sir, We read this recent review article with great interest, in particular the diagnostic algorithm illustrated, and we would like to suggest a modification to this algorithm based upon our recent experience. Several months ago a fifty-five year old male presented to our institution with an acutely swollen and tender left sternoclavicular joint. The patient was clinically septic, being systemically unwell with a swinging pyrexia, raised C-reactive protein/ erythrocyte sedimentation rate (CRP/ESR) and positive blood cultures growing S. Aureus. Initial imaging of the clavicle showed it to be anteriorly and laterally displaced with no evidence of osteomyelitis. A working diagnosis of septic arthritis was made, however, attempts to confirm the diagnosis were not successful, no fluid was aspirated from the joint and ultrasound did not demonstrate any fluid present. After performing an MRI of the joint, including the thorax, the diagnosis of upper lobe pneumonia causing pressure displacement of the sternoclavicular joint was made. A CT scan confirmed the diagnosis. Looking retrospectively after the diagnosis was made a chest radiograph was performed. This demonstrated a clearly visible area of apical lobe consolidation. The patient improved with appropriate antibiotic treatment. Given this experience we believe pneumonia should be added to the list of differential diagnoses of sternoclavicular joint disorders. As part of the investigation algorithm illustrated, a chest radiograph should be performed as an alternative or an adjunct to a clavicular radiograph as it would detect underlying pulmonary pathology and would also aid diagnosis by allowing comparison of both the sternoclavicular joints. A.S.C. Bidwai, SpR Trauma and Orthopaedics, D. Soo, T.N. Board, Wrightington, Wigan, Leigh NHS Trust, Wigan, UK.