Pain where the clavicle meets the sternum can be a source of discomfort, impacting everyday activities. This specific area involves the sternoclavicular (SC) joint, a crucial connection point for the upper body. Understanding the nature of this pain and its origins can help in seeking appropriate care.
Understanding the Sternoclavicular Joint
The sternoclavicular joint serves as the only direct skeletal attachment between the upper limb and the axial skeleton. Located at the base of the neck, it forms where the medial end of the clavicle meets the manubrium, the upper part of the sternum, along with the first costal cartilage. This articulation is a synovial saddle joint, allowing for a wide range of motion, which is important for the full movement of the arm and shoulder.
The joint’s stability comes from a robust joint capsule and strong ligaments. Key ligaments include the anterior and posterior sternoclavicular ligaments, which prevent excessive displacement, and the costoclavicular ligament, providing stability by anchoring the clavicle to the first rib. An articular disc, made of fibrocartilage, resides within the joint, enhancing its range of movement and acting as a shock absorber.
Common Causes of Pain
Pain in the sternoclavicular joint can arise from various distinct conditions. These conditions include inflammatory processes, injuries, and degenerative changes.
Sternoclavicular joint arthritis is a frequent cause. This can manifest as osteoarthritis, a “wear and tear” condition where the joint cartilage gradually deteriorates. Inflammatory types of arthritis, such as rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis, can also affect the SC joint, causing pain, swelling, and stiffness.
Traumatic events can lead to a sternoclavicular joint sprain or dislocation. Injuries result from direct blows to the shoulder, falls onto an outstretched hand, or collisions in sports or car accidents. A sprain involves stretching or tearing of the ligaments, while a subluxation means partial separation of the joint, and a dislocation indicates a complete separation of the bones. Posterior dislocations are less common but are considered more serious due to the proximity of vital structures like major blood vessels and airways.
Tietze’s syndrome or costochondritis can also cause pain in this region. These are inflammatory conditions affecting the cartilage connecting ribs to the sternum. While costochondritis involves multiple rib joints, Tietze’s syndrome specifically presents with localized swelling, tenderness, and pain, often at the sternoclavicular joint or other costochondral junctions.
Osteitis Condensans Claviculae is a less common, non-inflammatory condition characterized by benign bone thickening at the medial end of the clavicle. This condition can cause persistent pain and localized swelling.
Overuse or repetitive strain from certain activities can also contribute to SC joint pain. Activities involving repeated arm movements, such as those in some sports or occupational tasks, can place excessive stress on the joint and its surrounding tissues. This can lead to chronic inflammation and irritation.
Diagnosing the Source of Pain
Identifying the specific cause of sternoclavicular joint pain involves a thorough evaluation by a healthcare professional. This process combines information gathered from the patient with various diagnostic tests.
A medical history and physical examination are the initial steps. The doctor will inquire about the onset of pain, its characteristics, any associated activities or injuries, and overall health. During the physical assessment, the joint area will be palpated for tenderness, swelling, or warmth, and the range of motion of the shoulder and arm will be assessed. A visible deformity or bump over the joint may also be noted during this examination.
Imaging studies provide visual information about the joint and surrounding structures. X-rays are the first imaging test to rule out fractures or dislocations and can show signs of arthritis, such as narrowed joint space or bone spurs. For more detailed assessment of bone structures, a CT scan may be used. An MRI scan is useful for visualizing soft tissues, including ligaments, cartilage, and inflammation. An ultrasound might also be employed.
Blood tests can offer insights if an inflammatory condition or infection is suspected. These tests can check for markers of inflammation, such as erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), or indicate specific autoimmune conditions. Blood tests can help guide further diagnostic steps.
Treatment Approaches
Managing pain originating from the sternoclavicular joint involves a range of strategies. The chosen approach depends on the underlying cause and severity of the condition.
Conservative management is the first line of treatment. Rest and activity modification mean avoiding movements or activities that worsen the pain. Pain can be managed with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, and applying ice or heat to the affected area may help reduce swelling and discomfort. Physical therapy is recommended to improve joint flexibility, strengthen the muscles surrounding the shoulder, and enhance joint stability.
Medical interventions become an option when conservative measures are insufficient. Corticosteroid injections, which deliver anti-inflammatory medication directly into the joint, can provide pain relief and reduce inflammation. These injections are performed under imaging guidance to ensure precise placement. For specific inflammatory conditions like rheumatoid arthritis, prescription medications tailored to those diseases may be necessary to control systemic inflammation.
Surgical options are considered as a last resort, when pain is persistent, severe, or when conservative treatments have not provided adequate relief, or in cases of structural damage like chronic instability or severe arthritis. Procedures can include joint stabilization to repair or reconstruct damaged ligaments. In cases of severe arthritis, a small portion of the clavicle’s end might be removed (resection arthroplasty) to create more space and reduce bone-on-bone friction. Surgical fusion may be considered to eliminate motion and pain.