Osteoarthritis of the manubriosternal joint is rare. The diagnosis is not easy to make, and more serious causes of chest pain have to be ruled out first. We report one case that was treated with arthrodesis of the manubriosternal joint using double locking screw compression plating (LCP) with excellent results. Pre-operative CT-scan images with 3D reconstruction were used to measure the screw length and the drill stop depth. In this case report, we have shown that arthrodesis can be an effective way of treating osteoarthritis of the manubriosternal joint, when other measures fail. Furthermore, the use of a locking compression plate with appropriate and careful pre-operative planning affords a safe surgical technique, rapid pain relief and ultimately sound and asymptomatic union of the joint.