Condensing Osteitis of the Clavicle

Originally described by Brower et al. (1974) as a clavicular version of osteitis condensans ilii and osteitis pubis, this entity is clinically characterized by painful swelling of the medial end of the clavicle again in young women of child-

bearing age. Undue stress to the clavicle appears to be the cause. Pathology is not related to infection, neoplasm, or avascular necrosis. The main histological changes include apposi-tional trabecular thickening in the cancellous bone and periosteal reaction, which probably represent a response with bony proliferation to mechanical stress. Osteophytes are seen in some patients. Solovjev (1976) has recorded

Pubis Osteitis

Fig. 7.6A, B Chronic osteitis pubis with increased tracer uptake. A Anterior pinhole scan of the pubis in a 28-year-old female with painful chronic osteitis in the right sym-physis pubis shows increased para-articular uptake with apparent joint space widening (arrows). B AP radiograph reveals irregular para-articular sclerosis with bone defect (arrows). Patient had a history of marked dystocia

Fig. 7.6A, B Chronic osteitis pubis with increased tracer uptake. A Anterior pinhole scan of the pubis in a 28-year-old female with painful chronic osteitis in the right sym-physis pubis shows increased para-articular uptake with apparent joint space widening (arrows). B AP radiograph reveals irregular para-articular sclerosis with bone defect (arrows). Patient had a history of marked dystocia

Osteitis Pubis Radiographics

Fig. 7.7A, B Ancient osteitis pubis with decreased tracer uptake. A Anterior pinhole scan of the pubis in a 42-year-old female with old painless osteitis in the left symphysis pubis shows decreased para-articular uptake with minimal joint space widening (open arrow). B AP radiograph reveals reminiscent irregular para-articular sclerosis with bone defect (arrowheads). Decreased tracer uptake may reflect an atrophic state

Fig. 7.7A, B Ancient osteitis pubis with decreased tracer uptake. A Anterior pinhole scan of the pubis in a 42-year-old female with old painless osteitis in the left symphysis pubis shows decreased para-articular uptake with minimal joint space widening (open arrow). B AP radiograph reveals reminiscent irregular para-articular sclerosis with bone defect (arrowheads). Decreased tracer uptake may reflect an atrophic state the same disease under the term osteitis con-densans claviculae.

Radiographic changes include irregular os-teolysis and bony condensation in the lower aspect of the medial clavicular end with occasional spurring. Narrowing and subchondral cyst formation may be present in the adjacent sternoclavicular joint (Jurik et al. 1985). For the diagnosis of these changes, often not prominent, conventional X-ray tomography or CT is required (Fig. 7.8A).

Scintigraphically, the condition is characterized by intense tracer uptake (Teates et al. 1978). Pinhole scintigraphy reveals two different tracer uptake patterns: moderate uptake in the lower part of the medial clavicular end and rather conspicuous uptake in the sternocla-vicular joint (Fig. 7.8B). The findings basically differ from those of Friedrich's disease (osteo-chondrosis of the clavicle), in which uptake is sharply localized to the aseptic necrosis of the medial clavicular end (Fig. 13.5).

Condensing Osteitis

Fig. 7.9A, B Sternocostoclavicular hyperostosis. A Anterior conventional X-ray tomogram of the sternum in a 42-year-old man reveals a sawtooth-like synostosis between the medial ends of both clavicles and the first ribs (open arrows) and bony fusion of the sternoclavicular joints and the first costosternal junctions (arrowheads). The manubriosternal junction is also involved (not shown here). B Anterior pinhole scintigraph shows intense tracer uptake in the sternoclavicular (sc), costosternal (cs), and manubriosternal (ms) joints and their periarticular bones. The most conspicuous uptake is seen in the costo-clavicular synostosis (arrows) and the fused manubri-osternal junction (ms). The whole picture may well be likened to a "pansy flower"

Osteitis The Clavicle

Fig. 7.8A, B Condensing osteitis of the clavicle. A Anterior conventional X-ray tomogram of the sternoclavicular joints in a 48-year-old woman reveals irregular lysis and sclerosis in the medial end of the left clavicle (arrows) with narrowing of the adjacent sternoclavicular joint (arrowhead). B Pinhole scan shows intense tracer uptake in the lower aspect of the medial clavicular end (arrows) with relatively more prominent uptake specifically in the sternoclavicular joint that is involved secondarily (arrowheads)

Fig. 7.8A, B Condensing osteitis of the clavicle. A Anterior conventional X-ray tomogram of the sternoclavicular joints in a 48-year-old woman reveals irregular lysis and sclerosis in the medial end of the left clavicle (arrows) with narrowing of the adjacent sternoclavicular joint (arrowhead). B Pinhole scan shows intense tracer uptake in the lower aspect of the medial clavicular end (arrows) with relatively more prominent uptake specifically in the sternoclavicular joint that is involved secondarily (arrowheads)

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