Novel assessment of the sternoclavicular joint with computed tomography for planning interventional approach

Abstract

Increasing use of invasive diagnostic and treatment techniques dictate that a safe approach to the joint should be used to reduce the risk of iatrogenic injury. This study adds to existing knowledge of SCJ anatomy and its variation within the population. Understanding this can minimize the risk to adjacent structures when approaching the SCJ with injection needles or arthroscopic instruments.

Surgical Anatomy of the Sternoclavicular Joint

“…With its position noted in terms of a clock-face measurement, this landmark can serve as a reference for all other pertinent structures. We believe a clock-face orientation of the medial end of the clavicle is the most reproducible method for determining structure location, as large variations in clavicular size have been observed between individuals and even from side to side within the same individual 23,28 .…”

“…Currently, a paucity of information exists regarding the quantitative anatomy of the sternoclavicular joint 23 . The purpose of this study was to define the sternoclavicular joint anatomy, to quantify the ligament and muscle-tendon insertions surrounding the sternoclavicular joint, and to define pertinent osseous landmarks, which can serve as reproducible anatomical landmarks during sternoclavicular joint surgery.…”

Relationship of the Medial Clavicular Head to the Manubrium in Normal and Symptomatic Degenerated Sternoclavicular Joints

“…In the sagittal plane, the articular surface is, on average, directed 70°inferiorly 17 ; thus, a superior subluxation component would be suspected if there is anterior subluxation. Our study showed that, although there was a significant difference in the SAx distance between the arthritic side and the normal population, no patient had superior subluxation.…”

Arthroscopic Intra-articular Disk Excision of the Sternoclavicular Joint

“…Whereas the angle of inclination of the medial end clavicle in the axial plane is variable, the angle of inclination of the sternum has been found to be consistently 30 to the vertical. 17 The aim of the arthroscopic procedure is to excise the intra-articular part of the disk leaving an intact, stable circumferential rim.…”

“…The anterior sternoclavicular ligament, the small area of bony congruence, and the inclination of the sternal side of the SCJ are taken into consideration. 9,17 The bony contours of the joint are palpated and an initial inferior portal is positioned approximately 1 cm directly inferior to the joint line. An 18-gauge spinal needle is inserted and angled at 30 cephalad to the horizontal plane and 30 lateral to the midline to take into the inclination of the sternal side of the joint.…”