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Sternoclavicular Joint Syndrome

The sternoclavicular joint can serve as a source of pain that often may mimic the pain of cardiac origin. The sternoclavicular joint is a true joint and is susceptible to the development of arthritis, including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, Reiter's syndrome, and psoriatic arthritis. The joint is often traumatized during acceleration and deceleration injuries and blunt trauma to the chest. With severe trauma, the joint may subluxate or dislocate. Overuse or misuse also can result in acute inflammation of the sternoclavicular joint, which can be debilitating for the patient. The joint also is subject to invasion by tumor from primary malignant diseases, including thymoma, and metastatic disease (Fig. 78.19).

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On physical examination, the patient vigorously attempts to splint the joint by keeping the shoulders stiffly in neutral position. Pain is reproduced with active protraction or retraction of the shoulder and full …