Abstract
Objective
Plain radiographs of the sternoclavicular joint (SCJ) are difficult to interpret, and a CT or MRI scan is the usual investigation of choice. At our hospital, we use digital SCJ tomograms as our first-line investigation for all SCJ pathologies. We wanted to ascertain whether this is a safe and appropriate first-line imaging investigation.
Materials and methods
We retrospectively reviewed every patient who had undergone an SCJ digital tomogram (DT) over a 4-year period. We cross-referenced each patient with their records to assess the reason for referral, result, requirement for further investigation, diagnosis and management.
Results
We identified 132 SCJ tomograms over the study period. Twelve patients were referred from other hospitals with pre-existing imaging and were excluded. The reasons for radiological investigation in the remaining 120 patients were pain/lump without trauma (54.2%), pain/lump with trauma (30.8%) and post-operative review (15%). Of the 102 patients who had DT as their initial investigation, the most common diagnoses identified included osteoarthritis, normal SCJ, fracture and dislocation among others. Only 18 (17.6%) of these patients required further investigation with CT and/or MRI.
Conclusion
Our study is the first to assess digital tomography in SCJ pathology. We have shown that digital tomograms are an accurate and economically beneficial investigation for SCJ pathology and propose that it should be used as a first-line imaging investigation.
Similar content being viewed by others
References
Sewell MD, Al-Hadithy N, Le Leu A, Lambert SM (2013) Instability of the sternoclavicular joint: current concepts in classification, treatment and outcomes. Bone Joint J 95(B6):721–731
Tytherleigh-Strong G, Griffith D (2013) Arthroscopic excision of the sternoclavicular joint for treatment of sternoclavicular osteoarthritis. Arthroscopy 29(9):1487–1491
Low AK, Duckwroth DG, Bokor DJ (2008) Operative outcome of displaced medial-end clavicle factures in adults. J Shoulder Elbow Surg 17(5):751–754
Titchener A, See A, Van Rensburg L, Tytherleigh-Strong G (2018) Displaced medial end clavicular fractures treated with an inverted distal clavicle plate contoured through 90 degrees. J Shoulder Elbow Surg pii S1058-2746(18):30659–30661
Wirth MA, Rockwood CA (2009) Disorders of the sternoclavicular joint. In: Rockwood CA Jr, Matsen FA III, Wirth MA, Lippitt SB (eds) The shoulder, 4th edn. Saunders, Philadelphia, pp 527–560
Martetschlager F, Warth RJ, Millett PJ (2014) Instability and degenerative arthritis of the sternoclavicular joint: a current concepts review. Am J Sports Med 42(4):999–1007
Throckmorton T, Kuhn JE (2007) Fractures of the medial end of the clavicle. J Shoulder Elbow Surg 16(1):49–54
Pollack B (1953) Experiences with photography. Chest 24:663–669
Fam AG, Smythe HA (1985) Musculoskeletal chest wall pain. CMAJ 133(5):379–389
Jurik AG, Jensen LC, Hansen J (1996) Radiation dose by spiral CT and conventional tomography of the sternoclavicular joints and manubrium sterni. Skeletal Radiol 25:467–470
Mettler FA, Huda W, Yoshizumi TT, Mahesh M (2008) Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology 248(1):254–263
Iguchi Y, Kanehira Y, Tachibana M, Johnsen T (2004) Development of decommissioning engineering support system (dexus of the fugen nuclear power station. J Nucl Sci Technol 41:367–375
Morell DJ, Thyagarajan DS (2016) Sternoclavicular joint dislocation and its management: a review of the literature. World J Orthop 7(4):244–250
Van Tongel A, Valcke J, Pipers I, Verschueren T, De Wilde L (2014) Relationship of the medial clavicular head to the manubrium in normal and symptomatic degenerated sternoclavicular joints. J Bone Joint Surg Am 96(13):e109
Tytherleigh-Strong G, Rashid A, Lawrence C, Morrissey D (2017) Arthroscopic sternoclavicular joint discectomy for acute and chronic tears. Arthroscopy 33(11):1965–1970
Tytherleigh-Strong GM, Getgood AJ, Griffiths DE (2012) Arthroscopic intra-articular disk excision of the sternoclavicular joint. Am J Sports Med 40(5):1172–1175
Barcia AM, Zhou L, Cook JB, Lindell KK, Gumboc RD, Dykstra AD, Lachky RJ, Shaha SH, Taylor KF (2017) Digital tomography for detection of acute occult scaphoid fractures. Orthopaedics 40(6):e1092–e1095
Mermuys K, Vanslambrouck K, Goubau J, Steyaert L, Casselman JW (2008) Use of a digital tomosynthesis: case report of a suspected scaphoid fracture and technique. Skeletal Radiol 37(6):569–572
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Tytherleigh-Strong, G., Mulligan, A., Babu, S. et al. Digital tomography is an effective investigation for sternoclavicular joint pathology. Eur J Orthop Surg Traumatol 29, 1217–1221 (2019). https://doi.org/10.1007/s00590-019-02433-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00590-019-02433-3