化膿性胸鎖関節炎の1例

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Sternoclavicular joint (SCJ) infection is uncommon and accounts for 1-9% of all septic joints. Clinical recognition may be hampered by minor signs, symptoms and the tendency of SCJ pain to be referred to the shoulder. We experienced a case of septic arthritis of SCJ in which the first symptoms were shoulder pain, thus rendering an early diagnosis difficult. A 76-year-old man without predisposing risk factors presented with right shoulder pain after carrying a heavy mat suddenly. At first plain X-rays of the shoulder only were performed, but examinations of the SCJ were not performed in detail at all. After three days the patient complained of pain localized from the right SCJ to anterior chest. There was no swelling, redness or warmth, but tenderness over the right SCJ. Laboratory findings revealed the existence of an inflammation somewhere. But a first needle aspiration of the SCJ did not grow bacteria. Plain SCJ X-rays were unremarkable, but magnetic resonance imaging (MRI) and bone scintigraphy showed increased signal in the soft tissues around the SCJ. A second needle aspirate cultures grew methicillin-sensitive Staphylococcus aureus (MSSA). It took about two weeks to diagnose septic arthritis of the SCJ. He underwent drainage and antibiotic therapy. The operative findings revealed abnormal granulation in the SCJ, surrounding the joint and subclavian space. But because the inflammation did not improve, he underwent debridement again and continuous irrigation. After a year there is no recurrence. Pain due to septic arthritis of SCJ may be insidious in onset and referred to various anatomical locations, including the shoulder, neck, jaw, elbow, and can easily be confused with intrinsic shoulder or cervical spine pathologies. If the patients initially have pain referred to the shoulder, we should examine the SCJ carefully and then septic arthritis of the SCJ should be suspected.
2010-08-04

化膿性胸鎖関節炎の1例

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