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The neck, Thoracic Inlet and Outlet, the Axilla and Chest Wall, the Ribs, Sternum and Clavicles.
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
The first ribs are short, broad and relatively thick, and lie in a protected position at the base of the neck. Their heads articulate posteriorly with the upper part of either side of the first thoracic vertebra. Each first rib has two tubercles, one posterior and just lateral to the neck (which points upwards and backwards and which bears an articular facet for articulation with the transverse process of Dl), and a second mores anteriorly (between the grooves for the subclavian artery and vein) where the scalenus anterior muscle is inserted - the 'scalene tubercle'. The costoclavicular ligament normally connects the first costal cartilage with the under surface of the medial end of the clavicle and in some individuals there may be a small articular joint where the first rib so articulates, producing the 'rhomboid fossa' - see also p. 12.40 and Illus. RHOMBOID FOSSA.
Spontaneous Bilateral Sternoclavicular Joint Infections
Published in Wickii T. Vigneswaran, Thoracic Surgery, 2019
SCJ infections can be quite difficult to manage due to the persistent but destructive process in a region of the chest wall that is in close proximity to the great vessels. The management typically involves systemic IV antibiotics along with radical debridement of all involved tissues including resection of the bone and cartilage [1]. The infection is localized in only a minority of patients and often involves the adjacent clavicle and sternum [1]; it can also spread to the adjacent lung and may lead to a lung abscess. The costoclavicular ligament between the first rib and clavicle maintains stability and prevents any significant disability after resection of the SCJ and medial aspect of the clavicle. The extent of the infection can be evaluated preoperatively either with CT or MRI scans to allow proper surgical planning.
A to Z Entries
Published in Clare E. Milner, Functional Anatomy for Sport and Exercise, 2019
The sternoclavicular joint, between the sternum of the thoracic cage and the clavicle, has several ligaments associated with it. There are anterior and posterior sternoclavicular ligaments which pass directly across the joint. In addition, there is an interclavicular ligament which passes between the right and left clavicles, across the suprasternal notch. There is also a costoclavicular ligament lateral to the joint. This ligament passes from the first rib to the clavicle and assists in keeping the medial end of the clavicle in place.
A review of upper extremity deep vein thrombosis
Published in Postgraduate Medicine, 2021
Oneib Khan, Ashley Marmaro, David A Cohen
UEDVT can be categorized into primary or secondary in nature. Primary UEDVT is known as PSS or effort thrombosis and has an incidence of 1–2 per 100,000 based on regional referral center data [7]. This would implicate PSS in 10–20% of UEDVT cases. PSS was first described by Cruveilhier in 1816 and further elaborated on by Paget and von Schroetter in 1897 and 1894, respectively. In 1948, the term PSS was coined by Hughes in the first review of the phenomena [8]. The pathophysiology of PSS centers around vTOS (See Figure 2). This obstruction occurs because of interplay among multiple mechanisms. Firstly, in these patients, the costoclavicular ligament tends to have an abnormally lateral insertion onto the first rib. Secondly, these patients often have hypertrophy of their scalene muscles from athleticism or frequent use. Repetitive upper extremity movements in the setting of a narrowed venous thoracic outlet lead to trauma to the vein and surrounding tissue. Consequently, the microtrauma and endothelial damage induce focal venous stenosis and, as a result, venous stasis. This establishes conditions favorable for venous thrombosis [8,9]. The axilla-subclavian vein is primarily involved; however, extension to venous sites proximal and distal to the venous thoracic outlet is common. Given the need for repetitive movement in PSS, these patients tend to be younger and physically active. A study of 608 patients with PSS showed an average age of 32 years with 71% reporting occupations involving excessive motion of the upper extremity such as painting and hairdressing, or sports such as gymnastics, weightlifting, baseball, golf, football, and tennis [9].
Sports-related sternoclavicular joint injuries
Published in The Physician and Sportsmedicine, 2019
Justin E. Hellwinkel, Eric C. McCarty, Morteza Khodaee
The SCJ is the only articulation between the axial and appendicular skeleton of the upper limbs. The joint space contains a fibrocartilagenous disc between the sternal end of the clavicle and the manubrium, which is all surrounded by a thick fibrous capsule. Supporting ligamentous structures include the costoclavicular ligament (CCL) from the first rib, the interclavicular ligament, and sternoclavicular ligaments anteriorly and posteriorly (Figure 2). The stout soft tissue support allows for movement in all planes through the joint. The CCL is the primary supporting structure preventing superior displacement of the clavicle by opposing pull of the sternocleidomastoid muscle. Integrity of this ligament in medial clavicular injury yields superior outcomes compared to surgical reconstruction or absence of the ligament, underlining its importance for stability [4]. The CCL has the largest footprint of any supporting structure and can sustain an axial force of approximately 5000 N before failure [5]. The anterior and posterior sternoclavicular ligaments are thickened portions of the capsule that provide anterior and posterior stabilization of the medial clavicle [6,7]. The posterior sternoclavicular ligament provides greater strength and stability relative to the anterior ligament [6]. The clavicle is the first bone to ossify, although the medial clavicular physis does not completely fuse until 25 years of age [8]. Displaced Salter-Harris injuries can easily be misdiagnosed as SCJ dislocations in younger patients because of similar injury patterns and clavicular displacement. Given the physis is a weak connection near the SC junction, it is likely that physeal injury is more common than true dislocation in younger patients, though this distinction is difficult to evaluate [9].