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1
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Mok S, Almajed Y, Alomiery A, Soames R, Alashkham A. Morphology of the sternoclavicular joint and its microanatomical changes in response to osteoarthritic degeneration. Clin Anat 2024. [PMID: 39704465 DOI: 10.1002/ca.24253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 09/23/2024] [Accepted: 11/24/2024] [Indexed: 12/21/2024]
Abstract
Although the sternoclavicular joint shares structural similarities with the knee and hip joints as a diarthrodial joint, its biomechanics differ significantly due to its non-weight-bearing nature. Nevertheless, it is subject to considerable loading, leading to increased susceptibility to osteoarthritis, a prevalent condition characterized by the degeneration of the joint's articular surfaces and fibrocartilaginous intra-articular disc. The osteoarthritic degeneration of the fibrocartilaginous and cartilaginous surfaces of the sternoclavicular joint has been investigated, considering multiple factors. These include cell count, collagen alignment, surface fibrillation, cyst formation, and glycosaminoglycan content, with the findings deemed significant. However, current treatments for osteoarthritis of the sternoclavicular joint tend to focus on symptom management rather than active prevention of disease progression. Therefore, a detailed understanding of the anatomy, biomechanics, and morphological changes of the sternoclavicular joint during all stages of the osteoarthritic disease is essential for effective management to allow for maximum patient outcomes. This review explores the current literature on the anatomy of the sternoclavicular joint, starting with its structure and comparison to surrounding joints, biomechanics, and morphology, before considering the microanatomical changes that occur due to osteoarthritic degeneration. Early identification of osteoarthritic changes within this joint can enhance treatment and management outcomes before advancing joint degeneration, improving the quality of life for those affected.
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Affiliation(s)
- Sophie Mok
- Anatomy, Biomedical Sciences, University of Edinburgh, Edinburgh, UK
| | - Yousef Almajed
- Anatomy, Biomedical Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Roger Soames
- Centre for Anatomy and Human Identification, School of Science and Engineering, University of Dundee, Dundee, UK
| | - Abduelmenem Alashkham
- Anatomy, Biomedical Sciences, University of Edinburgh, Edinburgh, UK
- Zawia Faculty of Medicine, University of Zawia, Zawia, Libya
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2
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Fang Y, Li W, Yang K, Gong Y, Yan L, Chen S. The Ultrasound Perspective for Sternoclavicular Joint in Spondyloarthritis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:2223-2230. [PMID: 39177413 DOI: 10.1002/jum.16558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 07/05/2024] [Accepted: 08/12/2024] [Indexed: 08/24/2024]
Abstract
Spondyloarthritis (SpA) is a prevalent genetic disorder that significantly impairs mobility, particularly in the spine, sacroiliac, and peripheral joints. Recent evidence highlights early involvement of the sternoclavicular joint in SpA, which may serve as an initial indicator. Diagnosis often relies on CT and MRI, neglecting ultrasound's potential in identifying SpA-related sternoclavicular arthritis. This review focuses on the joint's anatomy, exploring ultrasound's diagnostic and therapeutic role in SpA-related sternoclavicular arthritis, aiming to provide insights for future ultrasound applications in SpA management.
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Affiliation(s)
- Yabin Fang
- Department of Ultrasound, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Ultrasound, First Affiliated Hospital of FujianMedical University Binhai Campus, Fuzhou, China
| | - Wenting Li
- Department of Ultrasound, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Ultrasound, First Affiliated Hospital of FujianMedical University Binhai Campus, Fuzhou, China
| | - Kaiyi Yang
- Department of Ultrasound, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Ultrasound, First Affiliated Hospital of FujianMedical University Binhai Campus, Fuzhou, China
| | - Yiran Gong
- Department of Ultrasound, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Ultrasound, First Affiliated Hospital of FujianMedical University Binhai Campus, Fuzhou, China
| | - Lei Yan
- Department of Ultrasound, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Ultrasound, First Affiliated Hospital of FujianMedical University Binhai Campus, Fuzhou, China
| | - Shuqiang Chen
- Department of Ultrasound, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Ultrasound, First Affiliated Hospital of FujianMedical University Binhai Campus, Fuzhou, China
- Department of Ultrasound, Fujian Provincial Hospital Affiliated to Fuzhou University, Fuzhou, China
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3
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Damschen J, Nowak M, Murphy A, Park S, Li X, Galvin J. Return to Sports After Closed Reduction of Acute Traumatic Posterior Sternoclavicular Joint Dislocations: A Systematic Review. Am J Sports Med 2023; 51:3076-3083. [PMID: 36472354 DOI: 10.1177/03635465221131900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Acute traumatic posterior sternoclavicular (SC) joint dislocation is a serious injury given its potential to cause cardiovascular and airway compromise that typically will require emergent closed reduction. There are limited data on the rate of return to sports (RTS) after this injury pattern when treated in a closed fashion. PURPOSE To systematically review the literature and evaluate (1) the rate of RTS after closed reduction of posterior SC dislocation and (2) the timeline for RTS after closed reduction of posterior SC dislocation. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review was performed using the PubMed, EBSCOhost, and Elsevier databases with the search term "sternoclavicular dislocation." Inclusion criteria were publications reporting successful closed reduction of posterior SC joint dislocation and containing data relevant to the study objectives. Exclusion criteria were cases with unsuccessful closed reduction, open surgical reduction, concomitant fracture, epiphyseal disruption, superior or anterior dislocation, subluxation injury, treatment without reduction, and atraumatic or congenital origins. RESULTS Sixteen studies and an additional forthcoming case at the authors' institution were identified to have documented RTS with a total of 31 patients. Of these patients, 23 (74%) in the cohort had full RTS. Eight of the 16 studies plus the additional case reported a timeline for RTS. The mean time to RTS was 3.1 months (range, 1-6 months). Of the 8 patients who did not return to preinjury sports or activity, 12.9% (4/31) reported restrictions with sports or activity, 6.5% (2/31) changed to a sport with less contact, 3.2% (1/31) experienced symptomatic recurrence requiring surgical stabilization, and 3.2% (1/31) quit the sport. CONCLUSION Closed reduction of acute traumatic posterior SC joint dislocations provides high RTS rates with low rates of secondary surgical stabilization. The mean time to RTS at the preinjury activity level was 3.1 months.
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Affiliation(s)
| | - Matthew Nowak
- Madigan Army Medical Center, Tacoma, Washington, USA
| | | | | | - Xinning Li
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Joseph Galvin
- Madigan Army Medical Center, Tacoma, Washington, USA
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Yoshida Y, Matsumura N, Yamada Y, Yamada M, Yokoyama Y, Miyamoto A, Oki S, Nakamura M, Nagura T, Jinzaki M. Dynamic evaluation of the sternoclavicular and acromioclavicular joints using an upright four-dimensional computed tomography. J Biomech 2023; 157:111697. [PMID: 37406603 DOI: 10.1016/j.jbiomech.2023.111697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/27/2023] [Accepted: 06/21/2023] [Indexed: 07/07/2023]
Abstract
In the analysis of the shoulder complex, the sequential changes occurring in the sternoclavicular and acromioclavicular joints during active shoulder motion are challenging to track. This study aimed to investigate the in vivo sternoclavicular and acromioclavicular joint motions during active elevation, including the sequential changes in these joint spaces using upright four-dimensional computed tomography (4DCT). Bilateral shoulders of 12 healthy volunteers upright 4DCT were obtained during active elevation similar to a "hands up" motion. The sternoclavicular and acromioclavicular rotation angles, joint distances, and closest points on the clavicle relative to the thorax and scapula were evaluated during 10°-140° of humerothoracic elevation. During humerothoracic elevation, the clavicle elevated, retracted, and rotated posteriorly relative to the thorax, whereas the scapula rotated upwardly, internally, and posteriorly relative to the clavicle. All the sternoclavicular and acromioclavicular joint rotation angles were significantly different at ≥ 30°-50° of humerothoracic elevation compared with 10° of humerothoracic elevation. The mean sternoclavicular and acromioclavicular joint distances were 2.2 ± 1.1 mm and 1.6 ± 0.9 mm, respectively. The closest points were located on the anteroinferior part of the medial and lateral clavicle in the sternoclavicular and acromioclavicular joints, respectively. Significant differences were observed in the acromioclavicular joint distance and anterior/posterior movements of the closest points in the sternoclavicular and acromioclavicular joints compared with 10° of humerothoracic elevation. Our sternoclavicular and acromioclavicular closest point results indicate that the impingement tends to occur at the anteroinferior part of the medial and lateral aspects of the clavicle and may be related to osteoarthritis.
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Affiliation(s)
- Yuki Yoshida
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Noboru Matsumura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Yoshitake Yamada
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Minoru Yamada
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Yoichi Yokoyama
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Azusa Miyamoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Oki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takeo Nagura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
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Olivier T, Kasprzak K, Herteleer M, Demondion X, Jacques T, Cotten A. Anatomical study of the sternoclavicular joint using high-frequency ultrasound. Insights Imaging 2022; 13:66. [PMID: 35380281 PMCID: PMC8982694 DOI: 10.1186/s13244-022-01167-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/27/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The purpose of the present study was to determine whether ultrasound enables assessment of sternoclavicular structures. METHODS A preliminary study in 3 cadavers was followed by an ultrasound study, performed by 2 musculoskeletal radiologists working in consensus, in 59 patients without history of trauma, surgery or pain in the sternoclavicular joint. The visibility, echogenicity and thickness of the sternoclavicular structures were assessed. RESULTS The anterior sternoclavicular ligament and the interclavicular ligament could be seen in all patients (mean thickness: 1.4 mm and 1.3 mm, respectively). The articular disc was clearly seen in 66.1% of cases, and shoulder antepulsion enabled analysis in an additional 20.3%. Intra-articular joint gas was frequent (33.89% of cases), preventing analysis of the disc in 2 patients. Only the superficial anterior aspect of the clavicular and sternal articular cartilages could be assessed. Joint effusion was seen in 6.8% of cases. Clavicular osteophytes, sternal osteophytes and bone irregularities at the anterior sternoclavicular ligament insertion were detected in 33.9%, 16.9% and 16.9% of cases, respectively. CONCLUSION The anterior sternoclavicular ligament, interclavicular ligament and anterior intra-articular structures can be visualized by ultrasound. This means of assessment may have clinical applications, particularly in patients with trauma or microtrauma.
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Affiliation(s)
- Timothée Olivier
- Service de Radiologie et Imagerie Musculosquelettique, CCIAL, CHU Lille, 59037, Lille, France
| | - Kevin Kasprzak
- Service de Radiologie et Imagerie Musculosquelettique, CCIAL, CHU Lille, 59037, Lille, France
| | - Matthias Herteleer
- Laboratoire d'Anatomie, Faculté de Médecine, Univ. Lille, Lille, France.,Unité de Taphonomie Médico-Légale et Anatomie (UTML & A), EA 7367, Univ. Lille, Lille, France.,Faculté de Médecine, Univ. Lille, Lille, France
| | - Xavier Demondion
- Service de Radiologie et Imagerie Musculosquelettique, CCIAL, CHU Lille, 59037, Lille, France.,Laboratoire d'Anatomie, Faculté de Médecine, Univ. Lille, Lille, France.,Unité de Taphonomie Médico-Légale et Anatomie (UTML & A), EA 7367, Univ. Lille, Lille, France.,Faculté de Médecine, Univ. Lille, Lille, France
| | - Thibaut Jacques
- Service de Radiologie et Imagerie Musculosquelettique, CCIAL, CHU Lille, 59037, Lille, France.,Faculté de Médecine, Univ. Lille, Lille, France.,MABLab - Marrow Adiposity and Bone Lab ULR4490-Univ. Lille, Lille, France
| | - Anne Cotten
- Service de Radiologie et Imagerie Musculosquelettique, CCIAL, CHU Lille, 59037, Lille, France. .,Faculté de Médecine, Univ. Lille, Lille, France. .,MABLab - Marrow Adiposity and Bone Lab ULR4490-Univ. Lille, Lille, France.
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Ayekoloye CI, Yin Q, Wood A, Frostick S. Open sternoclavicular osteophyte debridement in the surgical management of sternoclavicular osteoarthritis: clinical outcome of a new procedure. Shoulder Elbow 2022; 14:162-168. [PMID: 35265182 PMCID: PMC8899320 DOI: 10.1177/1758573220972093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 10/12/2020] [Accepted: 10/15/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Symptomatic sternoclavicular osteoarthritis is uncommon but remains the most frequent non-traumatic condition affecting the sternoclavicular joint and tends to have a predilection for middle-aged women. It responds well to conservative management. Surgery is indicated when conservative management fails. We present the clinical outcome of open symptomatic sternoclavicular osteophyte debridement, a new operation for treating recalcitrant symptomatic sternoclavicular osteoarthritis. METHODS Five patients (five symptomatic sternoclavicular joints) with symptomatic sternoclavicular osteoarthritis underwent open sternoclavicular debridement following failure of conservative treatment. There were three females and two males. Mean age was 46.6 years (range 37.17-66). Four cases were primary osteoarthritis and one case was secondary to trauma. They were reviewed at mean follow-up at 35.4 months with minimum follow-up of 29 months. Assessment included Quick Disabilities of Arm Shoulder and Hand (DASH) and subjective patient satisfaction score. RESULTS There was no post-operative complication. Mean Quick DASH score 10.9 (range 0-29.5) at mean 35.4-month follow-up (range 29-43 months). Three patients reported excellent and two reported good outcome as per subjective satisfaction score. CONCLUSIONS Open sternoclavicular debridement has proved to be a simple, safe and highly effective new surgical treatment for patients with symptomatic sternoclavicular osteoarthritis unresponsive to non-operative management.
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Affiliation(s)
- Charles I Ayekoloye
- Department of Orthopaedics, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, UK,Charles I Ayekoloye, Department of Orthopaedics, Royal Liverpool and Broadgreen Hospital, Liverpool L7 8XP, UK.
| | - Qi Yin
- Department of Orthopaedics, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, UK
| | - Amanda Wood
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Simon Frostick
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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Dobson M, Waldron T. SCJ osteoarthritis: The significance of joint surface location for diagnosis. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2019; 24:48-51. [PMID: 30278426 DOI: 10.1016/j.ijpp.2018.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/22/2018] [Accepted: 08/23/2018] [Indexed: 06/08/2023]
Abstract
An evaluation of the method used to diagnose sternoclavicular joint (SCJ) osteoarthritis (OA) in skeletal remains is presented, with particular attention given to the anatomy of the joint. The current palaeopathological diagnostic criteria used to identify SCJ OA were found to be appropriate for both the sternal and clavicular surfaces of the SCJ, with eburnation indicating perforation of the intra-articular disc and advanced disease. Eburnation was found to occur rarely in the SCJ, and if used as the sole diagnostic criterion would result in an underestimation of SCJ OA prevalence in archaeological assemblages. A key finding was the identification of changes characteristic of OA but confined to the attachment zone of the intra-articular disc on the clavicular surface of the SCJ. As this area of the joint is non-articular, and not normally covered with articular cartilage, a diagnosis of OA would be inaccurate and instead it should be considered as an enthesopathy. It is likely that SCJ OA has been incorrectly identified and over-diagnosed in the archaeological record in the past. More histological research into the disc attachment and its degeneration is required before this can be confirmed.
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Affiliation(s)
- Melissa Dobson
- UCL Institute of Archaeology, University College London, London, WC1H 0PY, UK.
| | - Tony Waldron
- UCL Institute of Archaeology, University College London, London, WC1H 0PY, UK
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8
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Edwin J, Ahmed S, Verma S, Tytherleigh-Strong G, Karuppaiah K, Sinha J. Swellings of the sternoclavicular joint: review of traumatic and non-traumatic pathologies. EFORT Open Rev 2018; 3:471-484. [PMID: 30237905 PMCID: PMC6134883 DOI: 10.1302/2058-5241.3.170078] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The sternoclavicular joint (SCJ) is an integral part of the shoulder girdle that connects the upper limb to the axial skeleton. Swelling of the SCJ is commonly due to trauma, degeneration, infections and other disease processes that affect synovial joints. This review also focuses on uncommon conditions that could affect the SCJ, including SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome, Friedrich’s disease and Tietze syndrome. The scope of this review is limited to the analysis of the current evidence on the various conditions affecting the SCJ and also to provide an algorithm to manage these conditions. Cite this article: EFORT Open Rev 2018;3:471-484. DOI: 10.1302/2058-5241.3.170078
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Affiliation(s)
| | - Shahbaz Ahmed
- Pulvertaft Hand Centre, Royal Derby Hospital, Derby, UK
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Rathcke M, Tranum-Jensen J, Krogsgaard MR. Possibilities for arthroscopic treatment of the ageing sternoclavicular joint. World J Orthop 2017; 8:536-544. [PMID: 28808624 PMCID: PMC5534402 DOI: 10.5312/wjo.v8.i7.536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 03/10/2017] [Accepted: 05/05/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate if there are typical degenerative changes in the ageing sternoclavicular joint (SCJ), potentially accessible for arthroscopic intervention.
METHODS Both SCJs were obtained from 39 human cadavers (mean age: 79 years, range: 59-96, 13 F/26 M). Each frozen specimen was divided frontally with a band saw, so that both SCJs were opened in the same section through the center of the discs. After thawing of the specimens, the condition of the discs was evaluated by probing and visual inspection. The articular cartilages were graded according to Outerbridge, and disc attachments were probed. Cranio-caudal heights of the joint cartilages were measured. Superior motion of the clavicle with inferior movement of the lateral clavicle was measured.
RESULTS Degenerative changes of the discs were common. Only 22 discs (28%) were fully attached and the discs were thickest superiorly. We found a typical pattern: Detachment of the disc inferiorly in connection with thinning, fraying and fragmentation of the inferior part of the disc, and detachment from the anterior and/or posterior capsule. Severe joint cartilage degeneration ≥ grade 3 was more common on the clavicular side (73%) than on the sternal side (54%) of the joint. In cadavers < 70 years 75% had ≤ grade 2 changes while this was the case for only 19% aged 90 years or more. There was no difference in cartilage changes when right and left sides were compared, and no difference between sexes. Only one cadaver - a woman aged 60 years - had normal cartilages.
CONCLUSION Changes in the disc and cartilages can be treated by resection of disc, cartilage, intraarticular osteophytes or medial clavicle end. Reattachment of a degenerated disc is not possible.
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10
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Minimum 2-year outcomes and return to sport following resection arthroplasty for the treatment of sternoclavicular osteoarthritis. J Shoulder Elbow Surg 2017; 26:e37-e43. [PMID: 27727060 DOI: 10.1016/j.jse.2016.07.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/27/2016] [Accepted: 07/01/2016] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The aim of this study was to assess the effect of open resection arthroplasty for osteoarthritis of the sternoclavicular (SC) joint on pain levels, functional outcomes, and return to sport. METHODS Patients from a single surgeon's practice who underwent open resection arthroplasty (maximum 10-mm resection) for SC osteoarthritis or prearthritic changes between November 2006 and November 2013 were retrospectively reviewed. This was an outcomes study with prospectively collected data. Preoperative and postoperative American Shoulder and Elbow Surgeons score, Quick Disabilities of the Arm, Shoulder, and Hand score, Single Assessment Numeric Evaluation score, several pain scores, and level of sport intensity were assessed. RESULTS Seventeen SC joints in 16 patients (9 female, 7 male) met inclusion criteria. Mean age at time of surgery way 41.1 years (range, 12-66 years). One patient refused participation in the study. Three SC joint resections (17.7%) required SC joint revision surgery. Minimum 2-year outcomes data were available for 11 of the remaining 13 SC joints (84.6%). The mean time to follow-up was 3.3 years (range, 2.0-8.8 years). Pain at its worst (P = .026), pain at competition (P = .041), the Quick Disabilities of the Arm, Shoulder, and Hand score (P = .034), and the ability to sleep on the affected shoulder (P = .038) showed significant improvement postoperatively. The average postoperative American Shoulder and Elbow Surgeons score was 83.3. The level of sports participation (P = .042) as well as strength and endurance when participating in sport (P = .039) significantly increased postoperatively. CONCLUSION Resection arthroplasty of the medial end of the clavicle in patients with osteoarthritis of the SC joint without instability results in pain reduction, functional improvement, and a high rate of return to sport at midterm follow-up.
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11
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12
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Katthagen JC, Marchetti DC, Dahl KD, Turnbull TL, Millett PJ. Biomechanical Comparison of Surgical Techniques for Resection Arthroplasty of the Sternoclavicular Joint. Am J Sports Med 2016; 44:1832-6. [PMID: 27159312 DOI: 10.1177/0363546516639302] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The optimal location and extent of medial clavicle resection for sternoclavicular (SC) joint resection arthroplasty are unknown. HYPOTHESIS Resection of the intra-articular disc alone cannot reliably decompress the SC joint, and a parallel resection technique will decompress the SC joint significantly more compared with the same amount with an oblique resection technique. STUDY DESIGN Controlled laboratory study. METHODS Force transmission through the SC joint was measured in 7 matched-pair human cadaveric SC joints in a dynamic tensile testing machine. The specimens were randomized to either a parallel or an oblique resection technique. An 80-N axial load was applied on the lateral clavicle toward the SC joint in each of the following 4 conditions: (1) intact joint, (2) after resecting the intra-articular disc, (3) after resecting 5 mm of the medial clavicle, and (4) after 10-mm resection. RESULTS Complete discectomy of all SC joints resulted in a significant reduction of force transmitted through the SC joint (P = .002). However, the varying anatomy of the disc was accompanied by a varying amount of joint decompression (95% CI, 29.8%-65.4%). Resecting 5 mm of the SC joint with the parallel technique decompressed the SC joint by a mean (±SD) of 76.7 ± 22.1 N compared with 37.8 ± 24.8 N with the oblique technique (P = .02). Decompression did not significantly differ between the groups after 10-mm resection (P = .18) using the parallel technique (89.4 ± 24.1 N) compared with the oblique technique (68.2 ± 31.6 N). Furthermore, 5-mm resection of the medial end of the clavicle with the parallel technique decompressed the SC joint by an amount similar to 10-mm resection with the oblique technique. CONCLUSION Resection of the disc alone did not reliably decompress each SC joint. Resection of 5 mm of the medial end of the clavicle with the parallel resection technique reliably decompressed the SC joint better than with the oblique resection technique. CLINICAL RELEVANCE This study provides baseline data on SC joint resection techniques and their mechanical effects. This knowledge can be implemented in clinical practice to treat patients with symptomatic posttraumatic arthritis of the SC joint.
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Affiliation(s)
| | | | - Kimi D Dahl
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Peter J Millett
- Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado, USA
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13
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Colio SW, Smith J, Pourcho AM. Ultrasound-Guided Interventional Procedures of the Wrist and Hand: Anatomy, Indications, and Techniques. Phys Med Rehabil Clin N Am 2016; 27:589-605. [PMID: 27468668 DOI: 10.1016/j.pmr.2016.04.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Acute and chronic wrist and hand conditions are commonly seen by neuromuscular and musculoskeletal specialists. High-frequency diagnostic ultrasonography (US) has facilitated advances in the diagnosis and interventional management of wrist and hand disorders. US provides excellent soft tissue resolution, accessibility, portability, lack of ionizing radiation, and the ability to dynamically assess disorders and precisely guide interventional procedures. This article review the relevant anatomy, indications, and interventional techniques for common disorders of the wrist and hand, including radiocarpal joint arthritis, scaphotrapeziotrapezoidal joint arthritis, trapeziometacarpal joint arthritis, phalangeal joint arthritis, first dorsal compartment tenosynovitis, ganglion cysts, and stenosing tenosynovitis.
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Affiliation(s)
- Sean W Colio
- Department of Physical Medicine and Rehabilitation, Swedish Spine, Sports, and Musculoskeletal Center, Swedish Medical Group, Seattle, WA, USA
| | - Jay Smith
- Departments of Physical Medicine & Rehabilitation, Mayo Clinic Sports Medicine Center, Mayo Clinic, Rochester, MN, USA; Department Radiology, Mayo Clinic Sports Medicine Center, Mayo Clinic, Rochester, MN, USA; Department Anatomy, Mayo Clinic Sports Medicine Center, Mayo Clinic, Rochester, MN, USA
| | - Adam M Pourcho
- Department of Physical Medicine and Rehabilitation, Swedish Spine, Sports, and Musculoskeletal Center, Swedish Medical Group, 600 E. Jefferson Street, Suite 300, Seattle, WA 98112, USA.
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Morell DJ, Thyagarajan DS. Sternoclavicular joint dislocation and its management: A review of the literature. World J Orthop 2016; 7:244-250. [PMID: 27114931 PMCID: PMC4832225 DOI: 10.5312/wjo.v7.i4.244] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 12/11/2015] [Accepted: 01/05/2016] [Indexed: 02/06/2023] Open
Abstract
Dislocations of the sternoclavicular joint (SCJ) occur with relative infrequency and can be classified into anterior and posterior dislocation, with the former being more common. The SCJ is inherently unstable due to its lack of articular contact and therefore relies on stability from surrounding ligamentous structures, such as the costoclavicular, interclavicular and capsular ligaments. The posterior capsule has been shown in several studies to be the most important structure in determining stability irrespective of the direction of injury. Posterior dislocation of the SCJ can be associated with life threatening complications such as neurovascular, tracheal and oesophageal injuries. Due to the high mortality associated with such complications, these injuries need to be recognised acutely and managed promptly. Investigations such as X-ray imaging are poor at delineating anatomy at the level of the mediastinum and therefore CT imaging has become the investigation of choice. Due to its rarity, the current guidance on how to manage acute and chronic dislocations is debatable. This analysis of historical and recent literature aims to determine guidance on current thinking regarding SCJ instability, including the use of the Stanmore triangle. The described methods of reduction for both anterior and posterior dislocations and the various surgical reconstructive techniques are also discussed.
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Pourcho AM, Sellon JL, Smith J. Sonographically guided sternoclavicular joint injection: description of technique and validation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:325-331. [PMID: 25614406 DOI: 10.7863/ultra.34.2.325] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The primary purpose of this investigation was to describe and validate a sonographically guided technique for injecting the sternoclavicular joint (SCJ) using a cadaveric model. METHODS A single experienced operator (J.S.) completed 13 sonographically guided SCJ injections on 7 unembalmed cadaveric specimens (4 male and 3 female) using an out-of-plane, caudad-to-cephalad technique to place 1 mL of diluted blue latex into the joint. Within 72 hours, study coinvestigators dissected each specimen to determine the injectate location. RESULTS All 13 injections accurately placed latex into the SCJ with a predilection for the clavicular side (accuracy, 100%; 95% confidence interval, 73%-100%). Three injections (23%) placed all latex on the clavicular side of the SCJ in the presence of a complete intra-articular disk. Dissection revealed incomplete degenerated disks in the remaining 10 joints. Seven of these injections (54%) clearly placed more than 80% of the latex on the clavicular side, whereas the remaining 3 injections (23%) showed nearly equal latex distribution between the clavicular and sternal sides. No injection resulted in neurovascular injury or extracapsular flow. CONCLUSIONS Sonographically guided SCJ injections can be considered in the diagnosis and management of patients presenting with medial shoulder pain syndromes and, using the technique described herein, have a predilection to target the clavicular portion of the joint. In younger patients with possible complete intra-articular disks or in patients with sternal-side conditions, practitioners should consider confirming sternal-side flow after injection or attempt to specifically target the sternal side of the joint.
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Affiliation(s)
- Adam M Pourcho
- Department of Physical Medicine and Rehabilitation, Mayo Clinic Sports Medicine Center, Mayo Clinic, Rochester, Minnesota USA
| | - Jacob L Sellon
- Department of Physical Medicine and Rehabilitation, Mayo Clinic Sports Medicine Center, Mayo Clinic, Rochester, Minnesota USA
| | - Jay Smith
- Department of Physical Medicine and Rehabilitation, Mayo Clinic Sports Medicine Center, Mayo Clinic, Rochester, Minnesota USA.
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Van Tongel A, Karelse A, Berghs B, Van Isacker T, De Wilde L. Diagnostic value of active protraction and retraction for sternoclavicular joint pain. BMC Musculoskelet Disord 2014; 15:421. [PMID: 25496003 PMCID: PMC4295279 DOI: 10.1186/1471-2474-15-421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 12/01/2014] [Indexed: 12/20/2022] Open
Abstract
Background Sternoclavicular joint (SCJ) arthropathy is an uncommon cause of mechanical pain. The aim of this study is to evaluate the diagnostic value of two active clinical tests for localizing the sternoclavicular joint as the source of mechanical pain. Methods All patients between June 2011 and October 2013 that visited the orthopedic departments of three hospitals with atraumatic pain in the area of the SC joint were evaluated. Local swelling, pain at palpation, pain during arm elevation and two newly described tests (pain during active scapular protraction and retraction) were evaluated. CT images were evaluated. The patients were then divided into two groups according to whether they had a ≥50% decrease in pain following the SCJ injection. Sensitivity and specificity for local swelling, the four clinical tests and CT-scan were measured. Results Forty eight patients were included in this study and SC joint pain was confirmed in 44. The tests with highest sensitivity were pain on palpation, (93% sensitivity) and pain during active scapular protraction (86%). CT-scan showed a sensitivity of 84%. Local swelling showed a high specificity (100%). Conclusion Pain at the SCJ during active scapular protraction is a good clinical diagnostic tool for SC arthropathy. Electronic supplementary material The online version of this article (doi:10.1186/1471-2474-15-421) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, B-9000 Gent, Belgium.
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Negri JH, Malavolta EA, Assunção JH, Gracitelli MEC, Pereira CAM, Bolliger Neto R, Croci AT, Ferreira Neto AA. Assessment of the function and resistance of sternoclavicular ligaments: A biomechanical study in cadavers. Orthop Traumatol Surg Res 2014; 100:727-31. [PMID: 25261174 DOI: 10.1016/j.otsr.2014.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 05/05/2014] [Accepted: 07/31/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Few biomechanical studies have assessed the resistance of the ligamentous structures of the sternoclavicular joint, and none have reproduced the physiological movements of the joint. Determining the structures that are injured in sternoclavicular dislocations is important for the surgical planning of acute or chronic ligament reconstruction. METHODS Forty-eight joints from 24 human cadavers were studied, and they were divided into 4 groups of 12 joints each (retraction, protraction, depression and elevation). Biomechanical testing assessed primary and secondary failures. The mechanical resistance parameters between movements that occurred on the same plane (depression versus elevation, protraction versus retraction) were compared. RESULTS The posterior sternoclavicular ligament was the most injured structure during the protraction test, but it was not injured during retraction. The anterior sternoclavicular ligament was the most affected structure during retraction and depression. The costoclavicular ligament was the most affected structure during elevation. Joint resistance was significantly greater during protraction movements when compared to retraction (P<0.05). CONCLUSION The anterior sternoclavicular ligament was the most affected structure during retraction and depression movements. During protraction, lesions of the posterior sternoclavicular ligament were most frequent during elevation, and the costoclavicular ligament was the most frequently injured ligament. The resistance of the sternoclavicular joint was significantly greater during protraction movement when compared to retraction. LEVEL OF EVIDENCE IV, basic science, biomechanics, cadaver model.
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Affiliation(s)
- J H Negri
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - E A Malavolta
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - J H Assunção
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil.
| | - M E C Gracitelli
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - C A M Pereira
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - R Bolliger Neto
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - A T Croci
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - A A Ferreira Neto
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
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Lee JT, Campbell KJ, Michalski MP, Wilson KJ, Spiegl UJA, Wijdicks CA, Millett PJ. Surgical anatomy of the sternoclavicular joint: a qualitative and quantitative anatomical study. J Bone Joint Surg Am 2014; 96:e166. [PMID: 25274794 DOI: 10.2106/jbjs.m.01451] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The quantitative anatomical relationships of the main ligamentous, tendinous, and osseous structures of the sternoclavicular joint have not been widely investigated. The purpose of this study was to provide a quantitative description of the sternoclavicular joint in relation to relevant surgical landmarks. METHODS We dissected eleven nonpaired, fresh-frozen cadaveric sternoclavicular joints from four men and seven women (mean age at death, fifty-three years; range, thirty-three to sixty-four years) and measured the ligaments, musculature, and osseous landmarks with use of a three-dimensional coordinate-measuring device. RESULTS The clavicular pectoralis ridge, located at the 9:30 clock-face position on a right clavicle, served as a reliable osseous landmark for reference to the soft-tissue attachments around the sternoclavicular joint. The costoclavicular ligament was the largest ligament of the sternoclavicular joint, with 80% greater footprint area than that of the posterior sternoclavicular ligament. Articular cartilage covered 67% of the medial end of the clavicle and was located anteroinferiorly. The sternohyoid muscle inserted directly over the posterior sternoclavicular joint and the medial end of the clavicle, whereas the sternothyroid muscle inserted 9.5 mm inferior to the posterior-superior articular margin of the manubrium and coursed 19.8 mm laterally along the first rib. An avascular plane that can serve as a "safe zone" for posterior dissection was observed in each specimen, posterior to the sternoclavicular joint and anterior to the sternohyoid and sternothyroid muscles. CONCLUSIONS The clavicular pectoralis ridge can be used as an intraoperative guide for clavicle orientation and tunnel placement in sternoclavicular ligament reconstruction. Sternoclavicular joint resection arthroplasty should avoid injuring the costoclavicular ligament, which is the largest sternoclavicular joint ligament. Resection of only the anteroinferior aspect of the medial end of the clavicle may provide adequate decompression while preserving the stability of the clavicle. The location of the sternohyoid and sternothyroid musculotendinous insertions appear to provide a "safe zone" for posterior clavicle and manubrial dissection.
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Affiliation(s)
- Jared T Lee
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite #1000, Vail, CO 81657. E-mail address for P.J. Millett:
| | - Kevin J Campbell
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite #1000, Vail, CO 81657. E-mail address for P.J. Millett:
| | - Max P Michalski
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite #1000, Vail, CO 81657. E-mail address for P.J. Millett:
| | - Katharine J Wilson
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite #1000, Vail, CO 81657. E-mail address for P.J. Millett:
| | - Ulrich J A Spiegl
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite #1000, Vail, CO 81657. E-mail address for P.J. Millett:
| | - Coen A Wijdicks
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite #1000, Vail, CO 81657. E-mail address for P.J. Millett:
| | - Peter J Millett
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite #1000, Vail, CO 81657. E-mail address for P.J. Millett:
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Warth RJ, Lee JT, Millett PJ. Anatomy and Biomechanics of the Sternoclavicular Joint. OPER TECHN SPORT MED 2014. [DOI: 10.1053/j.otsm.2013.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Van Tongel A, Valcke J, Piepers I, Verschueren T, De Wilde L. Relationship of the Medial Clavicular Head to the Manubrium in Normal and Symptomatic Degenerated Sternoclavicular Joints. J Bone Joint Surg Am 2014; 96:e109. [PMID: 24990983 DOI: 10.2106/jbjs.m.00623] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Clavicular prominence is common in patients with symptomatic degenerative sternoclavicular arthritis. It is unclear if this is caused by enlargement or subluxation of the clavicle. The aim of this report is to describe a reproducible measurement technique to evaluate the relationship of the medial clavicular head to the manubrium. METHODS One hundred normal sternoclavicular joints, twenty-five sternoclavicular joints with symptomatic degenerative arthritis, and twenty-five non-symptomatic sternoclavicular joints on the contralateral side were studied with three-dimensional (3D) reconstruction with use of computer modeling. The greatest width (anterior-posterior distance) and height (superior-inferior distance) of the clavicle in the sagittal plane were measured, and the positions of the anterior and superior borders of the medial clavicle and their distances to the frontal and axial planes, respectively, were evaluated. The ratio of the anterior-posterior distance to the anterior-frontal plane distance was measured to evaluate the anterior-posterior position of the clavicle and the ratio of the superior-inferior distance to the superior-axial plane distance was measured to evaluate its superoinferior position. If the ratio was not in the 95% normal range, the clavicle was defined as subluxated. The reproducibility of this technique was evaluated on the basis of the interobserver and intraobserver reliability. RESULTS This technique showed good interobserver and intraobserver reliability. The mean anterior-posterior and superior-inferior distances were significantly larger in association with symptomatic sternoclavicular arthritis than in the normal sternoclavicular joints (p < 0001). The clavicle was subluxated anteriorly in twenty-two of the twenty-five cases of symptomatic sternoclavicular arthritis, but it was not subluxated superiorly. CONCLUSIONS The medial clavicular head in patients with degenerative sternoclavicular arthritis is significantly larger than it is in the normal population, and it is usually subluxated anteriorly.
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Affiliation(s)
- Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium. E-mail address for A. Van Tongel:
| | - Jens Valcke
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium. E-mail address for A. Van Tongel:
| | - Iwein Piepers
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium. E-mail address for A. Van Tongel:
| | - Thomas Verschueren
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium. E-mail address for A. Van Tongel:
| | - Lieven De Wilde
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium. E-mail address for A. Van Tongel:
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Warth RJ, Lee JT, Campbell KJ, Millett PJ. Arthroscopic sternoclavicular joint resection arthroplasty: a technical note and illustrated case report. Arthrosc Tech 2014; 3:e165-73. [PMID: 24749040 PMCID: PMC3986585 DOI: 10.1016/j.eats.2013.09.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 09/23/2013] [Indexed: 02/03/2023] Open
Abstract
Open resection arthroplasty of the sternoclavicular (SC) joint has historically provided good long-term results in patients with symptomatic osteoarthritis of the SC joint. However, the procedure is rarely performed because of the risk of injury to vital mediastinal structures and concern regarding postoperative joint instability. Arthroscopic decompression of the SC joint has therefore emerged as a potential treatment option because of many recognized advantages including minimal tissue dissection, maintenance of joint stability, avoidance of posterior SC joint dissection, expeditious recovery, and improved cosmesis. There are, however, safety concerns given the proximity of neurovascular structures. In this article we demonstrate a technique for arthroscopic SC joint resection arthroplasty in a 26-year-old active man with bilateral, painful, idiopathic degenerative SC joint osteoarthritis. This case also highlights the pearls and pitfalls of arthroscopic resection arthroplasty for the SC joint. There were no perioperative complications. Four months postoperatively, the patient had returned to full activities, including weightlifting, without pain or evidence of SC joint instability. One year postoperatively, the patient showed substantial improvements in the American Shoulder and Elbow Surgeons score; Single Assessment Numeric Evaluation score; Quick Disabilities of the Arm, Shoulder and Hand score; and Short Form 12 Physical Component Summary score over preoperative baseline values.
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Affiliation(s)
- Ryan J. Warth
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Jared T. Lee
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | | | - Peter J. Millett
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A,The Steadman Clinic, Vail, Colorado, U.S.A,Address correspondence to Peter J. Millett, M.D., M.Sc., Center for Outcomes-based Orthopaedic Research, Steadman Philippon Research Institute, 181 W Meadow Dr, Ste 1000, Vail, CO 81657, U.S.A.
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Bak K, Fogh K. Reconstruction of the chronic anterior unstable sternoclavicular joint using a tendon autograft: medium-term to long-term follow-up results. J Shoulder Elbow Surg 2014; 23:245-50. [PMID: 23849677 DOI: 10.1016/j.jse.2013.05.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 04/21/2013] [Accepted: 05/02/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Chronic symptomatic anterior sternoclavicular (SC) instability is a rare condition with sparse treatment options. Owing to the rarity of the condition and the potential risk of fatal complications, only a few reports on treatment of this condition have been published. We evaluated a prospective series of patients with chronic anterior SC instability who underwent minimally open reconstruction with an autologous tendon graft. METHODS From 2002 to 2010, 32 consecutive patients underwent minimally open SC ligament reconstruction using a tendon autograft. A palmaris longus was used in 7 patients and a gracilis tendon autograft was used in 25. All patients with at least 2 years of follow-up were reviewed. Five were lost to follow-up. The remaining 27 patients (84.4%) were a median age of 35 years (range, 11-61 years) at surgery. Patients were evaluated with the Western Ontario Shoulder Instability (WOSI) score preoperatively and at follow-up at a median 54 months (range, 24-120 months) postoperatively. RESULTS The total WOSI score improved from a median of 44% (range 6%-62%) preoperatively to 75% (range, 13%-93%) at follow-up (P = .0001). Two failures (7.4%) occurred; after revision, both patients remained stable. After the operation, 17 of 25 patients (68%) complained of donor site morbidity, and 10 (40%) still had some discomfort at follow-up. No infections or local vascular complications occurred. CONCLUSIONS Miniopen SC joint reconstruction using a tendon autograft results in prolonged improvement in shoulder function in most patients with symptomatic anterior SC instability.
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Affiliation(s)
- Klaus Bak
- Parkens Privathospital, Copenhagen, Denmark.
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Van Tongel A, Van Hoof T, Pouliart N, Debeer P, D'Herde K, De Wilde L. Arthroscopy of the sternoclavicular joint: an anatomic evaluation of structures at risk. Surg Radiol Anat 2013; 36:375-81. [PMID: 23995518 DOI: 10.1007/s00276-013-1195-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 08/19/2013] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Recently, arthroscopy of the sternoclavicular joint (SCJ) has been described in clinical setting. The aim of this study is to examine the accessibility and safety of the SCJ by arthroscopy in a cadaveric model. MATERIALS AND METHODS An inferolateral and superomedial portal to the SCJ was created in 20 cadaveric specimens. After debridement, the specimens were dissected with a needle positioned in the portal tracts. The distance between the needles and bony landmarks, tendons and ligaments were measured. The integrity of the posterior capsule was evaluated macroscopically. In eight specimens, after anterior dissection, the needles were replaced by K-wires that perforated the posterior capsule to evaluate the distance to the neurovascular structures behind the SCJ. RESULTS Both portals were found to be safe while allowing good access to the joint. The superomedial portal went through the tendon of the sternocleidomastoideus muscle and the inferolateral portal through the pectoralis major muscle. The portals entered the capsule medial and lateral to the anterior sternoclavicular ligament. The posterior capsule was never perforated during debridement. The perforating K-wires, however, usually perforated either a major vein or artery, but were at a safe distance from the vagal nerve. CONCLUSIONS In this cadaver study, arthroscopy of the sternoclavicular joint could be used as a minimally invasive procedure allowing debridement of the joint without damaging the posterior capsule of the joint. If the capsule is inadvertently be breached, a major risk of neurovascular damage exists. We advise to have a backup of a cardiothoracic surgeon when performing this procedure.
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Affiliation(s)
- Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium,
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Sewell MD, Al-Hadithy N, Le Leu A, Lambert SM. Instability of the sternoclavicular joint: current concepts in classification, treatment and outcomes. Bone Joint J 2013; 95-B:721-31. [PMID: 23723264 DOI: 10.1302/0301-620x.95b6.31064] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The sternoclavicular joint (SCJ) is a pivotal articulation in the linked system of the upper limb girdle, providing load-bearing in compression while resisting displacement in tension or distraction at the manubrium sterni. The SCJ and acromioclavicular joint (ACJ) both have a small surface area of contact protected by an intra-articular fibrocartilaginous disc and are supported by strong extrinsic and intrinsic capsular ligaments. The function of load-sharing in the upper limb by bulky periscapular and thoracobrachial muscles is extremely important to the longevity of both joints. Ligamentous and capsular laxity changes with age, exposing both joints to greater strain, which may explain the rising incidence of arthritis in both with age. The incidence of arthritis in the SCJ is less than that in the ACJ, suggesting that the extrinsic ligaments of the SCJ provide greater stability than the coracoclavicular ligaments of the ACJ. Instability of the SCJ is rare and can be difficult to distinguish from medial clavicular physeal or metaphyseal fracture-separation: cross-sectional imaging is often required. The distinction is important because the treatment options and outcomes of treatment are dissimilar, whereas the treatment and outcomes of ACJ separation and fracture of the lateral clavicle can be similar. Proper recognition and treatment of traumatic instability is vital as these injuries may be life-threatening. Instability of the SCJ does not always require surgical intervention. An accurate diagnosis is required before surgery can be considered, and we recommend the use of the Stanmore instability triangle. Most poor outcomes result from a failure to recognise the underlying pathology. There is a natural reluctance for orthopaedic surgeons to operate in this area owing to unfamiliarity with, and the close proximity of, the related vascular structures, but the interposed sternohyoid and sternothyroid muscles are rarely injured and provide a clear boundary to the medial retroclavicular space, as well as an anatomical barrier to unsafe intervention. This review presents current concepts of instability of the SCJ, describes the relevant surgical anatomy, provides a framework for diagnosis and management, including physiotherapy, and discusses the technical challenges of operative intervention.
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Affiliation(s)
- M D Sewell
- The Shoulder & Elbow Service, The Royal National Orthopaedic Hospital, Stanmore, United Kingdom
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Villaseñor-Ovies P, Vargas A, Chiapas-Gasca K, Canoso JJ, Hernández-Díaz C, Saavedra MÁ, Navarro-Zarza JE, Kalish RA. Clinical Anatomy of the Elbow and Shoulder. ACTA ACUST UNITED AC 2012; 8 Suppl 2:13-24. [DOI: 10.1016/j.reuma.2012.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Accepted: 10/29/2012] [Indexed: 11/27/2022]
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