Ultrasound examination of the acromioclavicular joint. Anatomy of the acromioclavicular joint. Lecture for doctors

The clavicle is an articulation of the upper limb girdle that provides support for the shoulder joint and acts as a frame for it. With the help of this joint, the arm is attached to the human chest. The joint has a fairly high density, but it is very flexible. This allows the collarbone to rotate in three planes simultaneously. The pathology of the clavicular joint, which in the ICD has code 19.91, is described in the article below.

Shoulder structure

Anatomy of the clavicle joints

The clavicular joint is a joint formed by the clavicular notch and the sternal end of the clavicle. Hyaline cartilage covers the surfaces of the bones, but does not ensure a complete match in the shape of the two elements. This causes the fact that over time, movements become more difficult and sometimes even impossible.

Nature helps solve this problem in ways available to it. An intra-articular disc, located between two bones, is attached to the capsule and divides the joint into two parts, thereby eliminating bone friction and deformation.

The surface of the joint is covered with a dense capsule and is also sealed with fairly strong ligaments:

• sternoclavicular;
• costoclavicular;
• interclavicular.

All ligaments are different in shape and function; they limit the movement of the collarbone in a certain direction.

Anatomical structure

From the name it is immediately clear that the sternoclavicular joint is formed by the corresponding bones. From the side of the arm it is formed by the sternal segment of the clavicle, and from the chest - by the clavicular notch of the sternum. Various assumptions are made about the shape of this joint - it is argued that it is flat or spherical. These are incorrect points of view, since the range of movements is not suitable for a flat joint (too large), and for a spherical joint the opposite is true.

It would be correct to consider the joint to be simple, complex in structure and saddle-shaped in shape.

• Simple - since it is formed by only 2 bones, enclosed in one common shell (capsule).
• What makes it more complex is the presence of an intra-articular disc. This is a thin plate of cartilage, which fuses with the capsule at its edges. This allows you to divide the articular cavity into two halves that do not communicate with each other.
• Saddle-shaped means the articular surfaces are S-shaped. The joint of the thumb is arranged in a similar way in the body. This gives sufficient mobility and flexibility combined with strength.

An interesting feature is that the collarbone is only one bone formation that connects the arm to the human body.

Causes and mechanism of development of arthrosis of the clavicle

The main reason for joint dysfunction is wear and tear of the joint. This process can occur due to intense physical work of a person. Loaders, miners, and blacksmiths are susceptible to the development of pathology. In the process of carrying out their activities, representatives of these professions experience shoulder overload. They can develop the disease even at a fairly young age.

Clavicle pain

Other causes of the disease include injury to the joint, which is very easy to deform. This does not go unnoticed: a person is approaching osteoarthritis. The resulting sprains, dislocations, and fractures of the collarbone should not be ignored. It is mandatory to consult a doctor and follow all his recommendations.

Attention! If you have a clavicle injury, it is especially important to remain in bed for some time and not overload the joint with physical exercise.

Symptoms

Arthrosis of the sternoclavicular joint manifests itself with the following symptoms:

• manifestation of pain in the neck and shoulder area, while unpleasant sensations can occur even at rest, and when you try to move the shoulder, the pain intensifies;
• fatigue that occurs against the background of even slight mental or physical activity;
• limited movement of the shoulder as a result of contraction of the muscles of the forearms;
• spread of joint pain throughout the arm;

Arm pain

• the appearance of a sound resembling a crunch in the shoulder area.

Painful sensations may be more or less intense, but with tension caused by coughing or sneezing, the pain may become more pronounced. The symptoms of arthrosis cannot be ignored.

Function [edit]

The sternoclavicular joint allows the collarbone to move in three planes, predominantly in the anteroposterior and vertical planes, although some rotation also occurs. Description of movement - rise and depression. Muscles do not act directly on this joint, although almost all actions of the shoulder girdle or scapula cause some movement in this joint.

A unique double-hinged articular disc located at the junction of the clavicular head and arm allows movement between the clavicle and the disc during scapular elevation and descent. This disc also allows movement between the sternum (manubrium) and itself during protraction and retraction of the scapula. [4]

Diagnostics

Prescribing the correct treatment is only possible with a good diagnosis. It must be not only competent and correct, but also timely. The body is examined using the following methods:

• Arthrosis of the AC joint

• radiography;
• CT scan;
• MRI;
• X-ray;
• laboratory tests that can confirm or refute the infectious nature of the disease.

After the doctor has received all the data on the patient’s health status, he assesses the severity of the pathology and decides on prescribing a course of therapy. Treatment in accordance with the selected regimen should be started immediately.

Treatment

An arthrologist treats this pathology. Not every clinic has a specialist in this very narrow profile, so orthopedists, surgeons, and rheumatologists help solve this problem.

Treatment of arthrosis of the acromioclavicular joint can be either medicinal or surgical, which is directly dependent on the patient’s condition, the severity of the disease and the patient’s wishes. If a conservative path of therapy is chosen, then massage, gymnastics, physiotherapy, the use of medications and the prescription of exercise therapy are considered justified.

Drug treatment

For drug therapy, the following groups of drugs are most often prescribed:

• chondoprotectors that can partially or completely restore damaged cartilage (Glucosamine, Artra, Alflutop, Structum);
• anti-inflammatory drugs (non-steroidal), which relieve pain and eliminate inflammation (Diclofenac, Aceclofenac, Naklofen, Naproxen, Indomethacin);
• muscle relaxants (Mydocalm, Sirdalud);
• medications that improve blood circulation in damaged tissues (Tental, Nikoshpan, No-shpa).

Any conservative effect is usually supplemented with physiotherapeutic procedures: massage, cryotherapy, laser therapy.

Clavicle massage

The choice of treatment method is carried out, first of all, based on the stage of development of the disease. For grade 1 arthrosis, drug therapy is sufficient. In grade 2, medicinal treatment of the affected area is indicated, and only in some cases is surgical intervention justified. With grade 3, most often, medical treatment is ineffective, so the main route of treatment is surgery. During the manipulation, a replacement (both complete and partial) of the shoulder joint occurs.

Important! In the later stages of development of the described pathology, drug therapy is very rarely helpful. This means that a visit to a doctor should be made immediately as soon as the patient notices the first signs of illness and limited mobility in the chest.

The processes that occur in the body during the development of arthrosis cannot be reversed. The consequence of the disease is the development of pathological processes in other organs and systems of the body, disruption of the patient’s motor activity, and a decrease in the quality of his life.

• The main methods of treating arthrosis of the sternoclavicular joint, symptoms and prevention

ethnoscience

Traditional medicine is used as an auxiliary method of treating ACL of the shoulder joint. This is justified when prescribing conservative treatment to a patient, as well as as an aid in rehabilitation after surgery. The following substances and plants have proven themselves to be excellent:

• beeswax mixed with rendered lard and rubbed into the joint until completely absorbed;
• white cabbage leaves, which relieve pain and inflammation;
• lingonberries in the form of a decoction, taken two tablespoons per day;
• corn silk, prepared as a tincture and taken 4-5 times a day in the amount of one teaspoon;
• horseradish root, used as a compress, which is applied to the affected area;
• elecampane root infused with vodka and applied to the inflamed area until the pain disappears.

Arthritis of the clavicle is an unpleasant disease both from the point of view of sensations and from the point of view of the prognosis for restoration of the connection. All people at risk should take chondoprotectors that improve metabolic processes in cartilage tissue and the production of synovial fluid. The prescription of such drugs is the responsibility of the attending physician.

It is necessary to seek help not only when the pain becomes unbearable, but also at the moment of the first suspicion of problems with joint mobility. Patients who are overweight and have diabetes, as well as older citizens and professional athletes are especially susceptible to this type of inflammation.

Links[edit]

1. Jump up
   ↑ Cadogan, Mike (February 2010). "Dislocations of the sternoclavicular joint". Life in the Fast Lane. Retrieved June 2011. Check date values ​​in: |access-date=(help)
2. Rent CF. Ultrasound of the shoulder. Master Medical Books, 2013. Free section on sternoclavicular joint dislocation available at ShoulderUS.com
3. Jougon, Jacques B.; Lepront, Denis J.; Dromer, Claire E. H. (1996). “Posterior dislocation of the sternoclavicular joint leading to compression of the mediastinum.” Annals of Thoracic Surgery
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   61
   (2):711–3. DOI: 10.1016/0003-4975 (95) 00745-8. PMID 8572795.
4. Lippert, Lynn. Clinical Kinesiology and Anatomy, 4th Edition; pp.95-96.
5. Menez, C.; Kielwasser, H.; Faivre, G.; Loisel, F.; Obert, L. (01/01/2017). "Superior sternoclavicular dislocation: a case report". International Journal of Surgical Case Reports
   .
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   : 102–104. DOI: 10.1016/j.ijscr.2017.09.019. ISSN 2210-2612. PMC 5633822. PMID 28965084.
6. Terra, Bernardo Barcellos; Rodriguez, Leandro Marano; Padua, David Victoria Hoffmann; Martins, Marcelo Giovannini; Teixeira, João Carlos de Medeiros; De Nadai, Anderson (07/01/2015). "Sternoclavicular dislocation: case history and surgical technique". Revista Brasileira de Ortopedia (English edition)
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   (4): 472–477. DOI: 10.1016/j.rboe.2015.06.019. ISSN 2255-4971. PMC 4563050. PMID 26401506.

This article incorporates public domain text from page 313 of the 20th edition

"Grey's Anatomy"
(1918).

Causes

As with deforming arthrosis of other localizations, the factors causing the pathology of the described joints may vary significantly in different patients. Possible causes of osteoarthritis:

• Elderly age.
• Female.
• Menopause period.
• Hereditary predisposition.
• High loads on the upper limb.
• Injuries to the corresponding joint.
• Metabolic diseases.
• Arthritis of infectious nature.

The listed factors can cause pathology either individually or in combination with each other.

The sternoclavicular joint. Characteristic

The purpose of the joint is to connect the upper limbs with the chest by combining the bones of the clavicle and shoulder girdle with the torso. By its origin, the sternoclavicular joint is a rudiment, which is a connection of the upper or forelimbs not only in humans, but also in animals, starting with reptiles. It is very durable and is involved in hand movement, reformation. This is especially felt when raising your arms up and down. This connection allows the clavicle to move in three main axes, synchronizing with the shoulder joint, supported by a powerful and very strong ligamentous apparatus.

The disease is rare; its cause may be metastasis of infection during sepsis or infection of a closed traumatic injury to the joint.

Clinically, the disease is manifested by pain, aggravated by movement, and painful swelling. The body temperature is elevated, the pain increases gradually. The articulation area is moderately enlarged, the swelling is dense to the touch, sharply painful, with pronounced hyperemia of the skin. Attempts to move cause increased pain in the collarbone and joint. Fluctuations are not determined.

X-rays and CT scans show changes in the articular surfaces, widening of the gap, and sometimes bone destruction.

• Treatment of arthrosis of the acromioclavicular, sternoclavicular and costosternal joints

Purulent sternoclavicular arthritis should be differentiated from tuberculous lesions of the articulation. Clinical manifestations in this case are expressed in an increase in articulation without pronounced skin hyperemia with moderate pain. Sometimes a cold leak forms.

The disease is long-term, of secondary origin (the primary site of infection may be the lungs, much less often other organs). Radiological signs are bone damage in the form of foci of destruction. When cultured, the pus may be sterile; with a special examination, the microbacterium tuberculosis is detected. If there are fistulas, a biopsy confirms the diagnosis of tuberculosis.

Treatment of purulent arthritis of the sternoclavicular joint is surgical. The operation is performed under local infiltration anesthesia or intravenous general anesthesia.

A vertical or arcuate skin incision passes over the sternoclavicular joint.

Incisions used for purulent arthritis of the sternoclavicular joint and osteomyelitis of the sternum:

1,2 - arthritis of the sternoclavicular joint; 3 — osteomyelitis of the manubrium and body of the sternum; 4 — osteomyelitis of the xiphoid process

The skin, subcutaneous tissue, and own pectoral fascia are dissected. With an arcuate incision, the resulting flap is separated and retracted outward. The sternoclavicular ligament is incised directly above the joint and the sternoclavicular joint is exposed. Remove pus; the cartilage lining the joint is excised with a sharp scalpel. The flap is placed and fixed along the edges with separate sutures, narrowing the wound, and a thin drainage tube is brought to the joint for instillation of antiseptics.

In chronic osteomyelitis, the sequesters are removed, the granulations are scraped out with a sharp spoon and sutures are placed on the wound. The limb is fixed with a Kuzminsky splint or a Deso bandage for 2-3 weeks.

VC. Gostishchev

An important connection between the upper limb and the chest is the sternoclavicular joint. Thanks to him, a person raises his hands up or puts his hands behind his head. Inflammation of such a joint, arthritis, dislocation due to a direct blow or a fall on outstretched elbows can cause disruption of its functions and lead to loss of a person’s ability to work.

The joint of this part of the skeleton has a saddle shape. Movements in it occur due to the movement of one bone relative to another; there is the possibility of rotating the collarbone around its axis. On the outside, the joint is covered with a dense connective tissue capsule that protects it from injury. Inside there is a connecting element - an articular disc. It regulates pressure between bone structures. It is strengthened by the anterior costal surface and the sternoclavicular ligament.

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Connections of the bones of the upper limb girdle

Connections between the bones of the upper limb girdle and the skeleton of the body - sternoclavicular joint , art. sternoclavicularis

, (Fig. 4.23), is formed by the connection of the sternal end of the clavicle with the clavicular notch on the manubrium of the sternum.

1. Sternoclavicular joint, art. sternoclavicularis.

2. Bones forming the joint: sternum, sternum,

collarbone,
clavicula
;
articular surfaces: the clavicular notch of the manubrium of the sternum, incisura clavicularis manubrii sterni,
and the sternal end of the clavicle,
extremitas sternalis claviculae.
3. The joint capsule is attached to the edges of the articular surfaces: dense, fibrous.

4. By type: simple joint, art.simplex

, combined,
art.
combinatoria, with acromioclavicular joint,
art.
acromioclavicularis. 5. Shape – saddle-shaped, art. sellaris

(in 5% of cases - spherical,
art. spheroidea).
6. By the number of axes of rotation - biaxial, in 5% of cases multi-axial .

7. Movements: the collarbone makes the most extensive movements around the sagittal axis - up and down; around the vertical axis - forward and backward. Circular motion is possible around these two axes.

Rice. 4.23. Sternoclavicular joint, art. stenoclavicularis

(front view; on the left side of the specimen the joint is opened with a frontal incision).

1 – clavicula (dextra); 2 – lig. sternoclaviculare anterius; 3 – lig. interclaviculare; 4 – extremitas sternalis claviculae; 5 – discus articularis (art.o stemoclavicularis); 6 – costa (I); 7 – lig. costoclaviculare; 8 – art. stemocostalis (II); 9 – lig. sternocostalis intraarticulare; 10 – cart. costae (II); 11 – synchondrosis manubrii stemi; 12 – lig. stemocostale radiatum.

8. The joint is fixed: anterior and posterior sternoclavicular ligaments , ligg. sternoclaviculare anterius et posterius

;
interclavicular, lig.
interclaviculare (restrains the downward movement of the clavicle) and costoclavicular,
lig.
costoclaviculare (very strong, inhibits upward movement of the clavicle). Of the bones of the shoulder girdle, only the clavicle is connected at its medial end to the skeleton of the body, so the bones of the girdle have great mobility.

9. Accessory apparatus: there is an articular disc.

10. Blood supply, venous and lymphatic drainage, innervation:

Connections between the bones of the upper limb girdle, acromioclavicular joint, articulatio acromioclavicularis

(Fig. 4.24), flat in shape, with little freedom of movement.

1. Acromioclavicular joint, art. acromioclavicularis.

2. Bones forming the joint: scapula, scapula

, and collarbone,
clavicula
;
articular surfaces: the articular surface of the acromion, facies articularis acromialis,
and the acromial end of the clavicle,
extremitas acromialis claviculae.
3. The joint capsule is attached to the edges of the articular surfaces.

4. By type: simple joint, art.simplex

, combined,
art.
combinatoria , with sternoclavicular joint,
art.
sternoclavicularis. 5. Shape: flat , art. plana.

6. By the number of axes of rotation - multi-axis.

7. Movements are possible around all axes, but their volume is insignificant.

8. Fixing apparatus: acromioclavicular ligament, lig. acromioclavicularis

;
coracoclavicular ligament, lig.
coracoclaviculare, consisting of trapezoidal and conical ligaments,
ligg.
trapezoideum et conoideum. 9. Auxiliary element: in 1/3 of cases there is an articular disc, discus articularis.

10. Blood supply, venous and lymphatic drainage, innervation:

The proper ligaments of the scapula are three ligaments that are not related to the joints. The first of them is the coracoacromial ligament, lig. coracoacromiale

(a powerful cord connecting the acromion to the coracoid process).
Forms the “arch” of the shoulder joint, protecting the joint from above and limiting the movement of the humerus in this direction. The second is the superior transverse scapular ligament, lig.
transversum scapulae superius (thin tuft thrown over the notch of the scapula).
Together with the notch of the scapula, it forms openings for the passage of blood vessels and nerves. The third is the lower transverse ligament of the scapula, lig.
transversum scapulae inferius , a thin connective tissue cord running from the base of the scapular spine to the posterior edge of the glenoid cavity of the scapula. The transverse artery of the scapula passes through the opening limited by this ligament.