Abstract
Five middle-aged women presented with unexplained chronic swelling at the medial clavicle. None of the patients recalled a history of trauma and none experienced pain or other symptoms associated with the swelling. In all cases, suspicion of tumor prompted referral to an orthopedic oncologist; two cases were biopsied before referral. Radiological studies demonstrated degenerative changes confined to the medial clavicle in three cases, exophytic overgrowth of the medial clavicle and adjacent manubrium in one case, and bilateral degenerative changes on both sides of the joint in one case. Prolonged follow-up supported the diagnosis of a benign, likely degenerative condition. These cases demonstrate the tendency for a variety of degenerative changes to manifest clinically as swelling at the medial clavicle. Inherent properties of the clavicle may predispose the medial clavicle to such changes. Recognition of this entity may prevent unnecessary testing or surgical biopsy of patients with this condition in the future. A thorough differential diagnosis of swelling at the medial clavicle is also presented.
Introduction
Isolated swelling at the medial clavicle occurring in the absence of preceding traumatic injury is rarely encountered in clinical practice. Diagnostic difficulty may arise from the limited experience of any individual in dealing with this unusual complaint. The tendency for some benign clavicular conditions to appear aggressive radiographically may add to the difficulty. Numerous reports of patients with benign clavicular lesions describe how a correct diagnosis was reached only after a battery of diagnostic tests or biopsy had been performed to rule out neoplasm. Scant documentation of some benign conditions in the literature may contribute to the tendency to overlook these conditions. The senior author (GB), an orthopedic oncologist, has received in consultation a number of patients with asymptomatic enlargement of the medial clavicle (Fig. 1). Concern for neoplasm prompted referral to our service. Two cases were referred after biopsy was performed. The clinical and radiological features of five middle-aged women diagnosed with a painless, benign, likely degenerative condition affecting the medial clavicle are presented.