Sternoclavicular joint: look for capsular lift

Question 1Which group is at higher risk of sternoclavicular septic arthritis?

1. aPeople who inject drugs
2. bChildren with croup
3. cMarathon runners
4. dOffice workers with neck strain

Question 2What does a normal sternoclavicular joint look like?

1. aTwo bright bone surfaces with a narrow gap and a thin capsule close to the bone
2. bA single continuous bone surface
3. cBright fluid above the clavicle
4. dA large black pocket over the joint

Question 3What suggests an effusion?

1. aAn acoustic shadow under the clavicle
2. bStriated muscle above the joint
3. cA bright, smooth cortex
4. dAn anechoic or complex pocket lifting the capsule into a bulge

Question 4Does an effusion prove septic arthritis?

1. aNo: osteoarthritis, trauma and inflammatory arthritis also cause fluid
2. bOnly if it is anechoic
3. cOnly on the left side
4. dYes, always

Question 5Why avoid blind aspiration of this joint?

1. aThe joint has no capsule
2. bThe fluid is always too thick to aspirate
3. cUltrasound gel is toxic
4. dThe great vessels, pleura and mediastinum lie just behind it