Abstract
Objectives
To describe the plane of the sternoclavicular joint (SCJ) to aid planning of instrument orientation during invasive procedures.
Methods
Computed tomography (CT) images of 80 consecutive patients aged 25 to 40 years with appropriate chest imaging series were retrospectively reviewed. Patients with a previous median sternotomy, fused manubriosternal joint or fracture were excluded. The medial clavicle was found to vary greatly in its anatomy such that a representative morphology could not be described. The manubrium was found to be a more consistent structure and was examined in more detail.
The angulation of the SCJ was measured in three orthogonal planes using CT multiplanar reformats. Each SCJ (160 in total) was assessed for transverse, coronal, and sagittal angulation of the central manubrial articular surface in respect to the long axis of the manubrial body using a newly devised measurement technique.
Results
The mean angles (± standard deviation) of the SCJs were 62.4 ± 9.7° to the transverse plane, 149.3 ± 7.3° to the coronal plane and 69.8 ± 7.5 to the sagittal plane. There was no significant difference in transverse (p = 0.41) or sagittal (p = 0.60) angulation between sides, however there was a significant difference for the coronal plane (p = 0.04). No significant differences were noted between the sexes in any plane.
Conclusions
Increasing use of invasive diagnostic and treatment techniques dictate that a safe approach to the joint should be used to reduce the risk of iatrogenic injury. This study adds to existing knowledge of SCJ anatomy and its variation within the population. Understanding this can minimize the risk to adjacent structures when approaching the SCJ with injection needles or arthroscopic instruments.
Similar content being viewed by others
References
Robinson CM, Jenkins PJ, Markham PE, Beggs I. Disorders of the sternoclavicular joint. J Bone Joint Surg Br. 2008;90-B:685–96.
Rajaratnam S, Kerins M, Apthorp I. Posterior dislocation of the sternoclavicular joint: a case report and review of the clinical anatomy of the region. Clin Anat. 2002;15:108–11.
Restrepo CS, Martinez S, Lemos DF, Washington L, McAdams HP, Vargas D, et al. Imaging appearances of the sternum and sternoclavicular joints. Radiographics. 2009;29(3):839–57.
Ferri M, Finlay K, Popowich T, Jurriaans E, Friedman L. Sonographic examination of the acromioclavicular and sternoclavicular joints. J Clin Ultrasound. 2005;33(7):345–55.
Peterson CK, Saupe N, Buck F, Pfirrmann CWA, Zanetti M, Hodler J. CT-guided sternoclavicular joint injections: description of the procedure, reliability of imaging diagnosis, and short-term patient responses. Am J Roentgenol. 2010;195(6):W435–9.
Tavakkolizadeh A, Hales PF, Janes GC. Arthroscopic excision of sternoclavicular joint. Knee Surg Sports Traumatol Arthrosc. 2009;17:405–8.
Ernberg LA, Potter HG. Radiographic evaluation of the acromioclavicular and sternoclavicular joints. Clin Sports Med. 2003;22(2):255–75.
Billet FPJ, Schmitt WGH, Gay B. Computed tomography in traumatology with special regard to the advances of three-dimensional display. Arch Orthop Trauma Surg. 1992;111:131–7.
Lucet L, Le Loёt X, Ménard JF, Mejjad O, Louvel JP, Janvresse A, et al. Computed tomography of the normal sternoclavicular joint. Skeletal Radiol. 1996;25:237–41.
Klein MA, Miro PA, Spreitzer AM, Carrera GF. MR imaging of the normal sternoclavicular joint: spectrum of findings. Am J Roentgenol. 1995;165:391–3.
Brossmann J, Stäbler A, Preidler KW, Trudell D, Resnick D. Sternoclavicular joint: MR imaging-anatomic correlation. Radiology. 1996;198:193–8.
Aslam M, Rajesh A, Entwisle J, Jeyapalan K. Pictorial review: MRI of the sternum and sternoclavicular joints. Br J Radiol. 2002;75(895):627–34.
Klein MA, Spreitzer AM, Miro PA, Carrera GF. MR imaging of the abnormal sternoclavicular joint–a pictorial essay. Clin Imaging. 1997;21(2):138–43.
Tuscano D, Bannerjee S, Turk MR. Variations in normal sternoclavicular joints; a retrospective study to quantify SCJ asymmetry. Skeletal Radiol. 2009;38:997–1001.
Galla R, Basava V, Conermann T, Kabazie AJ. Sternoclavicular steroid injection for treatment of pain in a patient with osteitis condensans of the clavicle. Pain Physician. 2009;12:987–90.
Author information
Authors and Affiliations
Corresponding author
Additional information
No funding or grants were obtained for this study.
Rights and permissions
About this article
Cite this article
Wijeratna, M.D., Turmezei, T.D. & Tytherleigh-Strong, G. Novel assessment of the sternoclavicular joint with computed tomography for planning interventional approach. Skeletal Radiol 42, 473–478 (2013). https://doi.org/10.1007/s00256-012-1502-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00256-012-1502-6