The manubrium is the superior and widest segment of the sternum, forming the jugular notch at its superior border and articulating with both clavicles and the first rib cartilages. The manubriosternal angle (sternal angle of Louis) at its junction with the sternal body is the most important bony landmark in the thorax, marking the T4-T5 level, the second rib, the aortic arch, the carina, and the superior vena cava.
The manubriosternal joint is a secondary cartilaginous joint that allows a small degree of respiratory motion, and its ossification (synostosis) with age is normal and does not produce symptoms. A rare condition called manubriosternal joint dislocation in extreme hyperflexion produces a visible step deformity at the sternal angle. The jugular notch at T2-T3 is the landmark for central venous line insertion and for carotid artery pressure measurements.
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