Sternoclavicular Joint Pain Differential Diagnoses
- Osteoarthritis - joint space narrowing, subchondral sclerosis and cysts, osteophytes. Capsule hypertrophy is often prominent and can mimic neoplasm.
- Posttraumatic - Clavicular head fracture can lead to malunion and unilateral osteoarthritis
- Dislocation - usually anterior. If posterior then there is concern for tracheal or neurovascular injury. Often Salter-harris I fracture, the medial clavicle growth plate closes at 20-25.
- Neoplasm - lytic or blastic, usually sternum. Metastases from breast, lung, thyroid, kidney, colon. Primary malignancy is rare, includes chondrosarcoma, multiple myeloma, lymphoma.
- Septic arthritis - unilateral, periarticular osteoporosis, joint space narrowing, bone destruction, soft tissue swelling
- Metastatic calcification - periarticular calcium deposition, unilateral or bilateral, underlying hypercalcaemia in renal failure
- Ankylosing spondylitis - bilateral, symmetric, continuum of enthesopathy to ankylosis
- Psoriatic arthritis - bilateral, asymmetric, joint space narrowing, erosions, periostitis, enthesopathy
- Rheumatoid arthritis - bilateral, symmetric, erosive
- Osteitis condensans of clavicle - unilateral, in middle-aged women. Sclerosis of the inferior aspect of the clavicular head, inferomedial osteophyte
- Sternoclavicular hyperostosis/SAPHO syndrome - SAPHO = Synovitis, acne, pustulosis, hyperostosis, osteitis. Seen in older teenagers and adults, primarily men. Unilateral or bilateral sclerosis of clavicle, sternum or both, enthesitis. May affect manubriosternal and 1st and 2nd costochondral joints. Chronic multifocal osteoarthritis is a variant in children and adolescents with bone destruction, extensive sclerosis, leading to enlarged clavicle
- Mucopolysaccharidoses - wide clavicles
- Tumoral (idiopathic) calcinosis - periarticular calcium deposition
- Ischaemic necrosis of clavicle - Clavicular head sclerosis in children secondary to trauma, emboli.
Sternoclavicular Joint Pain and Instability