Manubriosternal joint dislocation in rheumatoid arthritis: the role of thoracic kyphosis.

Abstract

SUMMARY A case report of manubriosternal joint (MSJ) dislocation in a rheumatoid patient with thoracic kyphosis is presented together with a review of the relevant literature. Variations in the anatomical nature of the MSJ between normal individuals are described. In 43% of the population its characteristics are noted to be such that it may be involved in rheumatoid arthritis (RA). A joint thus involved can be dislocated by forces generated by longstanding thoracic kyphosis and transmitted to the manubrium via the first rib. Xeroradiographs of the MSJ region in our patient showed dislocation of the joint in the upright position and its subsequent reduction on lying the patient flat. We suggest that this demonstrated reduction is secondary to the lessening of the thoracic kyphosis that occurs in the supine position. It is concluded that in RA MSJ dislocation is a function of thoracic kyphosis.

Resection arthroplasty for luxation of the manubrio-sternal joint in rheumatoid arthritis—a case report

“…They did not mention the exact symptoms of the patients with subluxation of the MSJ, and nothing was written about the patients’ desire for treatment of their symptoms, if this should be available. Rapoport et al (1979) , Holt and Rooney (1980) , Wiseman (1981) , Khong and Rooney (1982) , and Kelly et al (1986) described 12 RA patients in total with thoracic kyphosis and MSJ dislocation. In the patients they described, 11 had severe kyphosis—as in our patient.…”

Symptomatic manubriosternal joint involvement in rheumatoid arthritis.

“…Manubriosternal joint subluxation has been documented and is associated with severe cervical spine disease,3 as well as with thoracic kyphosis. 4 Synovitis of the manubriosternal joint is presumably common but because of the relative immobility of the joint is seldom clinically apparent. When symptoms do occur the possibility of superimposed infection needs to be considered.…”

Manubriosternal dislocation type II associated with thoracic spine fracture: What can we learn from this?

“…morphological characteristics, such as kyphoscoliosis of the thoracic spine and joint alterations in patients with rheumatoid arthritis, predispose patients to manubriosternal luxation. [2,9,10] Thirupathi and Husted [11] distinguished two types of manubriosternal dislocations: the sternal body may be dislocated either posteriorly (type I) or anteriorly (type II) to the manubrium. Direct injury to the chest is the mechanism usually involved in type I (usually seen with direct impact or compression injury to the anterior chest), [3] whereas deceleration injuries resulting in hyperflexion with compression injury to the upper thorax, rheumatoid disease and kyphosis are the predisposing factors for type II.…”