General Surgeon HCA Citrus Hospital Inverness, Florida, United States
Case Diagnosis: A 60-year-old female with sternoclavicular joint effusion
Case Description: A 60-year-old female presents with painful swelling over the right supraclavicular area, worsening over the past year. Her vital signs are normal, and she denies any trauma. She has been previously evaluated by Orthopedics and Rheumatology without a clear diagnosis and reports no history of osteoarthritis or rheumatoid arthritis. Examination reveals non-erythematous, tender swelling above the right clavicle. Prior imaging showed no focal abnormalities on CT, but MRI revealed a 2.3 cm effusion with thickened peripheral enhancement in the right sternoclavicular joint. Based on the clinical history, physical examination, and unremarkable rheumatologic work-up, trauma, autoimmune, and infectious causes were deemed unlikely, pointing to an inflammatory origin, though the diagnosis remained uncertain. Conservative management was recommended with nonsteroidal anti-inflammatory medications, and follow-up was advised if symptoms persist, with corticosteroid injection considered as the next step.
Discussions: Sternoclavicular joint effusion is a rare and challenging condition to diagnose due to its overlap with several other diseases. Possible causes include infection (septic arthritis), inflammatory arthritis (such as rheumatoid arthritis), degenerative arthritis, trauma, tuberculosis, and transient sternoclavicular arthropathy. Imaging techniques such as ultrasound, CT, MRI, and bone scintigraphy are essential for ruling out conditions like infection or malignancy and for identifying erosions and synovitis. A thorough clinical evaluation is critical in determining the underlying etiology. Treatment varies depending on the cause, ranging from antibiotics for infections and disease-modifying drugs for inflammatory arthritis, to conservative management for conditions like transient sternoclavicular arthropathy.
Conclusions: This case highlights the diagnostic challenges of sternoclavicular joint effusion, where the underlying cause remained uncertain despite advanced imaging and multidisciplinary evaluation. Awareness of all potential causes and an understanding of appropriate diagnostic approaches are crucial for optimal management.
