A small bursa may develop between the anterior surface of the sternoclavicular joint capsule and the overlying skin and sternocleidomastoid tendon, reducing friction during clavicular motion. The SC joint also contains an intraarticular fibrocartilaginous disc, and synovitis in this joint can produce fluid accessible to aspiration.
Sternoclavicular joint bursitis and synovitis produce anterior chest pain and swelling at the medial clavicle that is reproduced by shoulder movements and direct palpation. SC joint septic arthritis, while uncommon, is disproportionately frequent in IV drug users due to the relatively poor vascular supply of the joint. Inflammatory arthritis (rheumatoid, psoriatic) commonly involves the SC joint. CT is preferred over MRI for assessing bony erosion; ultrasound guides aspiration and injection. SC joint resection for refractory arthrosis is effective but requires careful soft tissue reconstruction to prevent anterior instability.
IV drug use, immunosuppression, or haematogenous seeding produces SC joint septic arthritis with fever, medial chest wall swelling, and restricted shoulder movement; CT demonstrates joint space widening and erosion, and surgical drainage with joint debridement is required because the deep posterior structures (great vessels, trachea) risk secondary involvement.
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