The patient stated that due to the severity of pain, she had to compensate with an antalgic position favoring the opposite side and now affecting her posture. These episodes were described as throbbing pain to the right clavicle associated with radiating pain to the right shoulder and neck. She had experienced episodes of increased pain approximately one time per month, usually occurring at nighttime or during her menses. On initial evaluation in our clinic, in March 2021, the patient confirmed the pain in her right clavicle has continued intermittently since 2018. Axial (C, D) views demonstrating bony erosion (*) and marrow canal obliteration (black arrowheads). Coronal (A) and Sagittal (B) views depicting hook-like osteophytes in the inferior-medial clavicle (*). At this point, tissue sampling was recommended, and the patient underwent a right clavicle core needle biopsy, which demonstrated only lamellar trabecular bone and rendered nondiagnostic results despite an appropriate sample.Ĭhest CT without contrast obtained, September 2018, revealed a diffuse and expanded right clavicle with cortical breakthrough with scalloping and erosions. Among the malignant possibilities, lymphoma, osteosarcoma and even metastatic disease were deemed possible, although the suspicious was low for the later give the patient's age. A myriad of diagnostic alternatives was considered at time, such as osteomyelitis, fibrous dysplasia and synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome. No associated soft tissue mass or pathological fracture were noted ( Fig. 1). At the time, she underwent a computed tomography (CT) of the chest without contrast, which demonstrated an area of increased bone sclerosis within an expanded right medial clavicle with evidence of cortical breakthrough as well as scalloping and erosions. The patient had no significant past medical or surgical history, and specifically denied any history of osteomyelitis, trauma to the right clavicle, or autoimmune diseases. As prior history, in 2018 the patient initially presented with medial right clavicle pain and palpable enlargement. Here we described the case of a patient with worsening pain of the medial right clavicle that remained undiagnosed for years.Ī 29-year-old female was referred to our clinic in March 2021 for evaluation of right sided clavicle pain which had been affecting the patient for at least 3 years. The rarity of this disease, with scarcity of cases described in the literature, along its unspecific symptoms and imaging findings, with a myriad of differential diagnoses to be considered, can make its identification challenging for the treating physician. More advanced imaging studies such as CT scans or MRI demonstrate expansion of the medial clavicle, increased bone density in the area and edema. Diagnosis via radiographic imaging studies exhibits sclerosis and expansion at the medial end of the clavicle, a highly unspecific finding sometimes misdiagnosed as a bone malignancy.

Additional data advised a nonradical excision of the involved bone area in refractory scenarios. However, in certain cases, there may be recommendation for anti-inflammatory drugs, antibiotics and local corticosteroid injections, depending on the particular case and manifestation. In cases of asymptomatic or mild pain conservative management has been suggested. īased on the presentation of symptoms, treatment indications can differ. Some studies have identified a relationship between mechanical stress and degenerative changes of the sternoclavicular joint while others consider this a disease of infectious origin or even a true benign bone tumor unfortunately, the ultimate etiology remains still unknown,. Osteonecrosis in the affected area, confirmed by biopsy, may suggests this uncommon diagnosis. The clinical symptoms include edema and medial clavicle pain that worsens with abduction of the arm.

This disease presents in women of childbearing age, although male and pediatric patients have been described. Condensing osteitis of the clavicle is a rare benign disease first described in 1974 as an increase in bone density at the medial end of the clavicle.

Pathological disease of clavicle