Scapular, Clavicular, Acromioclavicular, and Sternoclavicular Joint Injuries
The chapter starts with a short overview of the relevant anatomy of bones and surrounding soft tissues. Most of an imaging part is focused on plain radiography discussing routine views as well as relevant special views, followed by the role of ultrasound,
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Abstract
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Introduction Scapula Clavicle Acromioclavicular Joint Sternoclavicular Joint
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2 2.1 2.2 2.3 2.4 2.5
Imaging Plain Radiography Ultrasound CT MRI Scintigraphy
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3 3.1 3.2 3.3 3.4
Specific Overuse Trauma Scapula Clavicle AC Joint SC Joint
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References
P. Brys (*) · E. Geusens Department of Radiology, University Hospitals Leuven, Leuven, Belgium e-mail: [email protected]
The chapter starts with a short overview of the relevant anatomy of bones and surrounding soft tissues. Most of an imaging part is focused on plain radiography discussing routine views as well as relevant special views, followed by the role of ultrasound, CT, MRI, bone scintigraphy, and SPECT-CT. The main part of the chapter is dedicated to specific overuse trauma, including typical overuse lesions of the immature skeleton. Discussed bony lesions are fractures, the rare stress fractures of scapula and clavicle, stress-related growth plate injury of the coracoid process and medial clavicle, lateral acromial apophysitis, and distal clavicular osteolysis. Joint pathology comprises acromioclavicular and sternoclavicular sprain or dislocation and AC joint osteoarthritis. Typical nerve pathologies of this anatomical area are the suprascapular nerve entrapment and the long thoracic neuropathy.
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1
Introduction
1.1
Scapula
The scapula is a flat bone with three prominences, the spine and acromion, the glenoid, and the coracoid process. Medial to the base of the coracoid process is the scapular notch arched by the superior transverse scapular ligament. The
Med Radiol Diagn Imaging (2020) https://doi.org/10.1007/174_2020_250, © Springer Nature Switzerland AG
P. Brys and E. Geusens
spinoglenoid notch arched by the inferior transverse scapular ligament is situated between the lateral margin of the base of the scapular spine and the dorsal side of the glenoid. Both notches are important fixation points along the course of the suprascapular nerve.
1.2
Clavicle
The growth plates of the medial and lateral clavicular epiphyses do not fuse until the age of 25 years. The deltoid, trapezius, and pectoralis major muscles have important attachments to the clavicle. The deltoid muscle inserts onto the anterior surface of the lateral third of the clavicle, and the trapezius muscle onto the posterior aspect. The pectoralis major muscle inserts onto the anterior surface of the medial two thirds.
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Sternoclavicular Joint
The synovium-lined SC joint is formed by the medial clavicle, the clavicular notch of the manubrium, and the cartilage of the first rib (Fig. 2). Interposed between the fibrocartilaginous joint surfaces is a usually complete fibrocartilaginous disc, which acts to reduce the incongruities between the articulating joint surfaces, and as a shock absorber against medial translation of the clavicle. The anterior and posterior SC ligaments are thic
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