A bursa at the manubriosternal joint (angle of Louis), situated between the manubrium and the body of the sternum. This secondary cartilaginous joint has a fibrocartilaginous disc that may develop an associated bursa in response to repeated stress or inflammatory arthropathy.
Manubriosternal bursitis presents as localised sternal pain at the angle of Louis, exacerbated by trunk extension and deep breathing. It is associated with ankylosing spondylitis, rheumatoid arthritis, and SAPHO syndrome. The angle of Louis is a key anatomical landmark for the tracheal bifurcation and the 2nd rib, so accurate localisation of pathology here is important. Ultrasound confirms joint effusion and bursitis.
Pain and swelling at the angle of Louis from bursitis or joint arthropathy, associated with inflammatory spondyloarthropathy and reproduced by direct sternal palpation at the manubriosternal junction.
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