Is inflammation and pain at the sternoclavicular joint also called costochondritis?

Is Sternoclavicular Joint Inflammation Called Costochondritis?

No, inflammation and pain at the sternoclavicular joint is not costochondritis—these are distinct anatomical entities with different clinical implications. Costochondritis specifically refers to inflammation of the costochondral junctions (where ribs meet cartilage) or chondrosternal joints (where costal cartilages meet the sternum), not the sternoclavicular joint 1, 2.

Anatomical Distinction

• Costochondritis involves the costochondral junctions of ribs or chondrosternal joints of the anterior chest wall, typically affecting ribs 3-7, most commonly left-sided or retrosternal 1, 2
• Sternoclavicular joint inflammation is a separate entity involving the articulation between the clavicle and sternum, which may be part of conditions like chronic non-bacterial osteitis (CNO) or sternoclavicular hyperostosis (SCCH) 3

Clinical Significance of the Distinction

Sternoclavicular Joint Pathology

• Sternoclavicular and sternocostal joint involvement can be an early manifestation of inflammatory spondyloarthritis, with anterior chest wall pain affecting a significant percentage of patients with axial spondyloarthropathy 3, 4
• In adults with sterile bone inflammation (CNO), the disease mostly manifests as osteitis of the anterior chest wall, including the sternoclavicular region 3
• MRI demonstrated 62.5% sensitivity in determining sternoclavicular and sternocostal involvement by inflammatory spondyloarthritis in patients presenting with anterior chest wall pain 3

Costochondritis Characteristics

• Costochondritis is characterized by reproducible tenderness on palpation of the affected costochondral joints, typically ribs 3-7 1, 2
• Pain is described as stinging (53%) or pressing (35.1%), commonly retrosternal (52%) or left-sided (69.2%) 1
• Most nontraumatic musculoskeletal chest wall pain (42%) is attributed to costochondritis 1

Diagnostic Approach

For Suspected Sternoclavicular Pathology

• Initial imaging evaluation for adults with suspected CNO should include MRI or CT combined with nuclear imaging 3
• Whole-body imaging at initial evaluation can be considered for diagnostic and prognostic purposes when systemic inflammatory disease is suspected 3
• MRI can provide specific information regarding disease activity and severity, particularly for manubriosternal joint involvement 3

For Suspected Costochondritis

• Physical examination with systematic palpation of costochondral joints to identify areas of tenderness is the hallmark diagnostic finding 1, 4
• For patients older than 35 years or with cardiac risk factors, obtain an ECG to rule out cardiac causes first 1, 4
• Chest radiography may be useful as an initial imaging test, though ultrasound has higher sensitivity than CT for detecting costochondral involvement 4

Critical Pitfall to Avoid

Do not assume all anterior chest wall pain is costochondritis. Sternoclavicular joint involvement may indicate underlying systemic inflammatory disease such as spondyloarthritis or CNO, requiring different diagnostic workup and treatment approaches 3. The sternoclavicular joint is anatomically and pathologically distinct from the costochondral junctions, and misidentifying sternoclavicular pathology as costochondritis may delay diagnosis of serious systemic conditions 3.