25Feb

Breast-clavicular joint: structure, function and disease

Contents:
  • Anatomy of articulation
  • Joint functions
  • Methods for assessing joint condition
  • Possible diseases

The chest and clavicle joint is one of the main articulations of the upper limb belt, which creates a strong and reliable framework for the shoulder joint that binds the human arm to the chest. Despite the high strength of the joint, it is also very flexible, which allows the clavicle to move, and with it and the entire upper limb in three different planes.

Thanks to this joint, a person can raise his hands up, lead them by the head, perform rotational movements in the shoulders. If the function of the sternoclavicular joint suffers because of trauma or disease, then movements in the shoulder joint in full volume become impossible.

The sternoclavicular joint has, as it were, a double meaning. On the one hand, it limits mobility in the belt of the upper limb, ensuring its stability, and on the other hand it helps to carry out the high-amplitude movements.

Anatomy of articulation

The sternoclavicular joint is formed by a clavic notch on the sternum and the sternal end of the clavicle. The articular surfaces of the bones are covered with hyaline cartilage, which does not provide complete congruence.

For reference: congruence of the joint is a complete mutual correspondence of the shape of the articular surfaces of bones that are articulated to each other. If the surface of the joint loses congruence, then the movements become hard, and in some cases impossible.

But nature took care of the man and found the perfect solution to such a problem. With regard to the sternoclavicular joint, the issue of complete congruence is solved with the intra-articular disc, which is located between the articular surfaces of the two bones, without articulating with them. It is attached around the perimeter to the capsule of the joint. This disc divides the joint cavity into 2 separate parts: the lower middle and upper lateral. In some people, the intraarticular disc may have a hole in the middle and both joint cavities in such cases are connected together.

Breast-clavicular joint
So the sternoclavicular joint

looks. Among the anatomists there are still discussions about the classification of this junction. Some experts say that the joint is flat, while others insist that it is spherical in function, others call it saddle. Since for the flat joint the amplitude of the movements is too large, and for the spherical joint, on the contrary, it is too low, we will assume that the sternoclavicular joint is saddle, simple and complex in structure.

A simple joint is one that is formed by no more than two articular bone surfaces.

Complex joint is one that contains additional cartilage components inside the joint capsule to ensure congruency. In this case it is an intraarticular cartilaginous disk.

The saddle joint is one that is formed by two articular surfaces that seem to sit astride each other. In this case, the movements are carried out by sliding one bone along the other. This provides mobility in two mutually perpendicular axes. But, as it was said, movements in the sternoclavicular junction are possible in 3 planes( there is also a small rotation in the amplitude of the sternal end of the clavicle), which was the reason for the disputes of scientists. But, according to the majority opinion, this articulation is still considered a saddle.

Above, the joint is covered with a dense capsule and sealed with a few very strong ligaments:

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  1. Breast-clavicular ligament( anterior and posterior), which strengthen the capsule of the articulation along the anterior, upper and posterior surfaces. They are wide, but short, can be woven into the connective tissue of the capsule.
  2. The costal-clavicular ligament begins from the upper edge of the first rib and is attached to the clavicle. It is very dense, wide and strong. It inhibits increased mobility in the joint to the top and stabilizes the belt of the upper limb.
  3. The interclavicular ligament is stretched between the two sternal ends of the clavicle above the jugular breaststroke. It limits the unnecessary mobility of the collarbone down.

Joint functions

Anatomical features of the structure of the sternoclavicular joint allow movement in it in three planes:

  • around the vertical axis( reduction and dilution of the shoulders and shoulder blades);
  • around the sagittal axis( raising and lowering the shoulders);
  • around the front axis( rotational movements in the shoulders).

Also, the sternoclavicular joint is the only joint that connects the axial skeleton of a person with the upper limb. It should be noted that in man this joint is to some extent rudimentary, that is, one that has lost its functional purpose in the course of evolution and erectness. In animals, it performs much more functions, and the amplitude of movements in it is very large.

Movement in the sternoclavicular joint
The diagram shows the amplitude of possible movements in the joint

Methods for assessing the joint condition

In this paired connection, all types of movements are combined with those in the acromioclavicular and humeral joints. Assess its condition can be by examination, palpation and additional research methods( radiography, MRI, CT).

Inspection

Visually, visual examination of the joint can not always be clearly considered, since a well developed subcutaneous fat can interfere with this. In people with excessive body weight, articulations are not visible, but in individuals with asthenic physique( in lean), the joint is clearly contoured. Helps to identify the articulation of the lifting of the shoulders. Normally, both sternoclavicular joints are symmetrical, the color of the skin over them is not changed, there is no swelling, the movements are free, painless and are not accompanied by crepitus( crunching).

In case of deformation of skin hyperemia over articulation, pain or limitation of amplitude during movements, edema should be suspected of any pathology( disease or trauma).

Osteoarthritis of the sternoclavicular joint
In thin people, the sternoclavicular joint is well visible and is available for visual inspection. In this image you can clearly see the deformation of the left articulation

Palpation

The joint is felt by the doctor with the 2nd and 3rd finger of one hand. To improve the quality of palpation, it is necessary to raise the shoulders and bring the joints into an advantageous position for research. To better assess mobility, the patient is asked to take his shoulders back. In this case, the capsule is stretched from the front.

Normally the joint is not painful when feeling, there is no swelling and an increase in the local skin temperature, there is no crepitation or deformation, the amplitude of movements is within the normal range.

Of the additional methods of research, chest x-rays are most often used. In particularly severe cases, it may be necessary to perform magnetic resonance imaging or computed tomography for diagnosis.

Radiography and computed tomography of the sternoclavicular joint
Radiography and computed tomography make it possible to study the joint structure well and detect possible damage

Possible diseases

As already mentioned, any lesions of this joint affect the possibility of free movements of the upper limb and significantly reduce the quality of life of such patients. Any daily activity in them is accompanied by pain and inability to perform the necessary movement. Consider the most frequent types of diseases of the sternoclavicular joint.

Osteoarthritis

Osteoarthritis of this joint refers to the rare and little-known localization of this disease. Most often it occurs after trauma and has a one-sided nature, it is very rare to find simultaneous damage of both compounds.

Most often, this disease occurs under the mask of the humerus periarthritis, arthrosis of the shoulder joint, intercostal neuralgia, osteochondrosis, angina pectoris. Very often, such patients are exposed to the wrong diagnosis, which leads to a long and unsuccessful treatment.

The following signs will help in diagnosis:

  • soreness when feeling the area of ​​the sternoclavicular joints;
  • deformation development in this part of the body;
  • slight swelling;
  • presence of crunch when moving;
  • discomfort and pain when lying on the stomach.

Diagnosis is assisted by radiography of the articulation area, where pathological changes typical for arthrosis are revealed.

Treatment of this disease lends itself well. Apply therapeutic exercise, manual therapy, physiotherapy, medicines to eliminate acute pain. If necessary, blockade the area of ​​connection with glucocorticosteroid drugs.

Arthritis

This is an inflammation of the sternoclavicular joint, which can have several causes. Most often this joint is affected by reactive polyarthritis( Reiter's syndrome).Acute purulent arthritis can also develop when entering the infection in the joint cavity. In some cases, this compound can be retracted into a pathological process in systemic autoimmune diseases, for example, in rheumatoid arthritis, Bechterew disease, etc.

Arthritis Symptoms:

  • acute joint pain that increases with any movement;
  • edema and redness of the skin over the articulation, increased local temperature;
  • the inability to move freely by hand due to pain syndrome;
  • common signs: fever, malaise, muscle pain, weakness.
Arthritis of the sternoclavicular joint
So it looks arthritis of the sternoclavicular joint

Treatment of arthritis of the sternoclavicular joint depends on its cause. Therefore, when these signs appear, you need to seek help from a therapist, orthopedist or rheumatologist. If you do not treat arthrosis, then ankylosis of the joint may occur, that is, the complete disappearance of the joint cavity and immobility. And this condition can be corrected only by surgical treatment.

Injuries to

Most often you have to deal with a dislocation in the sternoclavicular joint, with a partial or complete rupture of its ligaments.

The development of such an injury is associated with a direct damaging effect in this area, for example, with a blow or fall on a straightened arm laid back.

There are two possible dislocations: anterior and posterior( depending on where the sternal end of the sternum has moved to the front or back of the sternum).

Suspected dislocation will help such symptoms:

  • sharp pain at the site of the injury, which increases with any movement;
  • increasing edema, deformation of this anatomical zone, bruising, bruising;
  • at palpation it is possible to grope the displaced end of a clavicle;
  • significant limitation of active hand movement and sharp soreness when trying passive movements;
  • when pressing on the clavicle, you can find increased bone mobility, which is normally absent.
Dislocation of the sternoclavicular joint
Anterior dislocation with a displacement of the sternal end of the clavicle on the front surface of the sternum

When the clavicle dislocates, there is a risk of injuring the organs of the neck and chest, so the patient should be immediately taken to a trauma hospital where he will be provided with all the necessary assistance.

Depending on the type of damage and its degree, treatment can be conservative or surgical.

There are more rare diseases of the sternoclavicular joint, for example, Friedrich's syndrome( aseptic necrosis of the sternal head of the clavicle), SAPHO syndrome( combination of a hyperostosis of the sternoclavicular junction with pustular lesions of the palms and soles, psoriasis or acne, spinal injury in the form of osteitis, arthritis, sakroileita), but they are found in isolated cases.

Thus, the sternoclavicular joint is a small, but very important articulation in our body. A violation of the function of this joint leads to the inability to perform hand movements, to significant discomfort, loss of ability to work and a decrease in the quality of life of such patients.

Breast-clavicular joint