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Dislocations of the sternoclavicular joint are uncommon, with the posterior variety having a potential for considerable morbidity. Radiologic management and diagnosis can be difficult. In this review article, the joint anatomy and mechanisms of dislocation are discussed and the incidence and clinical manifestations described. Six case reports are presented to illustrate causative mechanisms, diagnoses, and radiologic appearances. Computed tomography is the best method of demonstrating the sternoclavicular joint, but a number of specialized plain film projections are also described and illustrated; these should be more widely known. Treatment of the joint dislocations is briefly discussed.

We describe 7 manual laborers with painful, palpably enlarged metacarpophalangeal joints. Characteristic radiographic changes were joint space loss, prominent osteophytes, and cystic metacarpal heads most prominent in the second and third metacarpophalangeal joints. In 3 of 4 patients, joint biopsy specimens showed subsynovial fibrosis and villous hyperplasia. All 7 patients had similar backgrounds of heavy work demanding sustained gripping motions of both hands, for periods that exceeded 30 years. We designated their Degenerative joint disease involving the fingers typically affects the distal interphalangeal (DIP) and proximal interphalangeal (PIP) joints, with relative sparing of the metacarpophalangeal (MCP) joints (I ,2). Clinicians evaluating severe osteoarthritic changes in the MCP joints tend to consider diagnoses of secondary osteoarthritis (OA) resulting from hemochromatosis (3-8) or calcium pyrophosphate dihydrate (CPPD) crystal deposition (9-13). Both disorders are associated with bilateral degenerative arthropathy usually involving the second and third MCP joints, with loss of articular space, sclerosis, and cyst formation (3-15).We recently identified painful degenerative MCP arthropathy in a group of 7 farmers and laborers, aged 51 years or older. The most prominent clinical feature was restricted range of motion, and radiographic abnormalities included loss of joint space and large osteophytes in the second and third MCP joints. Because MCP arthropathy may be a prominent manifestation of hemochromatosis (6,16-18) or pyrophosphate arthropathy (9-13), metabolic diseases were considered and were excluded after thorough clinical evaluations and MCP joint biopsies. The term metacarpophalangeal arthropathy associated with manual labor is suggested for this arthropathy because it appeared to be related to prolonged labor that involved gripping with both hands. We concluded that MCP arthropathy, mimicking that seen in hemochromatosis and pyrophosphate arthropathy, occurred in the absence of underlying metabolic disorders. Although factors such as generalized OA

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Three cases of congenital diaphragmatic hernia in the adult are reported. Strangulation of the large bowel was the presenting feature in 1 case and pancreatitis in another. The abnormality was discovered as a coincidental finding in a third case. The incidence, presentations, and diagnosis of this uncommon condition are discussed.