Sternum

Cure Arthritis Naturally

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The sternum is provided with three articulations: the paired sternoclavicular joints and the single manubriosternal joint. The former joints consist of the medial end of the clavicle and the clavicular notch along with the superior surface of the first costal cartilage and articular disk. The manubriosternal joint is mostly symphysis and partly synovial with cavitation created by disk absorption. The periarticular bony surfaces are covered by hyaline cartilage and connected by a fibrocartilage that may be ossified in the elderly.

The sternoclavicular joints are common sites of rheumatoid arthritis and involvement is usually bilateral, and the manubriosternal joint is affected in 30% to 70% of patients with rheumatoid arthritis (Resnick 2004). All three joints may occasionally be affected at the same time. Radiography reinforced by conventional or computed tomography is the diagnostic method of choice. As in other joints, the radiographic changes of rheumatoid arthritis of the sternum include bone erosions, widening or narrowing of the joint space, osteolysis, ebur-nation, and ankylosis (Fig. 10.23A). Pinhole scintigraphy shows diffusely increased tracer uptake, obliterating the joints symmetrically (Fig. 10.23B) or singly when the manubriosternal joint is the seat (Fig. 10.24). As in this case, isolated involvement of a single joint is not rare (Fig. 10.24). The manubriosternal joint may appear spuriously widened due to para-articular osteolysis (Fig. 10.25) and be rarely defor-

Arthritis The Breastbone

Fig. 10.23A, B Rheumatoid arthritis of the sternum. A Anteroposterior radiograph of the sternoclavicular joints in 42-year-old female shows subchondral erosions, articular narrowing and mild eburnation (arrows). B Anterior pinhole scan reveals diffusely increased tracer uptake in both sternoclavicular joints symmetrically (arrows)

Fig. 10.23A, B Rheumatoid arthritis of the sternum. A Anteroposterior radiograph of the sternoclavicular joints in 42-year-old female shows subchondral erosions, articular narrowing and mild eburnation (arrows). B Anterior pinhole scan reveals diffusely increased tracer uptake in both sternoclavicular joints symmetrically (arrows)

med due to subluxation. The tracer uptake in rheumatoid arthritis is diffuse and symmetrical, contrasting with discrete and asymmetrical uptake in tuberculous arthritis (Fig. 8.23) and osteoarthritis (Fig. 9.29). Costosternocla-vicular hyperostosis clinically and radiogra-phically resembles rheumatoid arthritis, but the "pansy flower" sign with the extra-articular involvement is pathognomonic of the former condition (Fig. 7.6).

Sternoclavicular Joint

Fig. 10.25A, B Widening of the manubriosternal and sternoclavicular joints in rheumatoid arthritis. A Oblique radiograph of the upper sternum in a 41-year-female shows apparent widening of the manubriosternal joint (open arrow) and right sternoclavicular joint due to periarticular bone resorption and erosions (pairs of arrows). B Anterior pinhole scan reveals gaping of the manubriosternal joint (open arrows) and patchy uptake in the sternoclavicular joints (solid arrows)

Fig. 10.24A, B Rheumatoid arthritis of the manubri-osternal joint. A Lateral radiograph of the upper sternum shows blurring of the manubriosternal joint with soft-tissue swelling (arrow). The finding is inconclusive. B However, anterior pinhole scan reveals a patchy area of prominent tracer uptake in the manubriosternal joint (arrow)

Fig. 10.25A, B Widening of the manubriosternal and sternoclavicular joints in rheumatoid arthritis. A Oblique radiograph of the upper sternum in a 41-year-female shows apparent widening of the manubriosternal joint (open arrow) and right sternoclavicular joint due to periarticular bone resorption and erosions (pairs of arrows). B Anterior pinhole scan reveals gaping of the manubriosternal joint (open arrows) and patchy uptake in the sternoclavicular joints (solid arrows)

Arthritis The Breastbone

Fig. 10.26A, B Involvement of the second and third metatarsophalangeal and interphalangeal joints in rheumatoid arthritis. A Dorsoplantar radiograph of the right foot in a 33-year-old female shows regional osteopenia in the second through fifth toes with articular narrowing. B Dorsal pinhole scan reveals intense tracer uptake in the affected joints (arrows)

Fig. 10.26A, B Involvement of the second and third metatarsophalangeal and interphalangeal joints in rheumatoid arthritis. A Dorsoplantar radiograph of the right foot in a 33-year-old female shows regional osteopenia in the second through fifth toes with articular narrowing. B Dorsal pinhole scan reveals intense tracer uptake in the affected joints (arrows)

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