Sternoclavicular Joint: A New Axial Radiographic View

Abstract

There has been, to date, no satisfactory radiographic view described for evaluating anteroposterior displacement of the manubrial end of the clavicle in relation to the sternum. Most useful information in evaluating sternoclavicular joint injuries has come from digital palpation and manipulation and from the history. There is usually no great problem in diagnosing complete dislocations, especially the anterior variety. A single postero-anterior view will reveal cephalocaudad displacement. Various oblique and lateral views are also informative, and laminagrams may or may not be helpful. In various tumorous, inflammatory, and traumatic cases, however, because of edema, pain or only a minor degree of subluxation, it becomes difficult to assess the problem accurately. In these latter situations, axial roentgenograms may be quite useful. These can be obtained by the following new technic, which utilizes the relatively dense dorsal and ventral cortices of the sternum-manubrium as reference lines for antero-posterior displacement of either clavicle. Technic The patient should be seated on an adjustable stool in such a way that his costal margin rests comfortably on the cassette, while the corner of the table presses into the epigastrium. The degree of forward lean must be estimated so that a tangent of the sternoclavicular joint is perpendicular to the table. The lean will vary from the asthenic to the barrel-chested individual. Experience has shown that most technicians will underestimate the degree of forward lean by five or ten degrees initially. Elbows straddle the cassette, and the head can usually be stabilized comfortably in the hands, even in the acute, frank dislocation. The chin is brought forward a little, away from the manubrium, and the back of the neck is positioned parallel to the table. The roentgen source is rested on the nape, and exposure is then made through the cervical spine. Acknowledgment: My thanks go to Abraham Franco, R.T., for his technical aid.