Sclerosis of the Medial Ends of the Clavicles

Differential considerations include:

• Normal variant: This appears to be the case shown above. The patient was asymptomatic, and the image is identical to that presented in Keats (5-109).
• Osteitis condensans: Rare. Invariably unilateral. Primarily affects women between the ages of 20 to 60. Patients present after months or years of intermittent or steady pain localized to the medial end of the involved clavicle.
• Osteoarthritis: Joint space narrowing and subchondral sclerosis and subchondral cysts on both sides of the joint.
• Sternoclavicular hyperostosis: Rare. Typically bilateral. Hyperostosis and soft tissue ossification between the clavicles and anterior portions of the upper ribs and the sternum.
• Infection: Osteomyelitis or septic arthritis of the sternoclavicular joint. May see joint space narrowing, bone destruction, periosteal reaction, and soft tissue swelling.
• Friedrich disease: Rare. Ischemic necrosis of the medial clavicular epiphysis. Soft tissue swelling and pain over the medial end of the clavicle are typically present. A notch defect may be seen at the clavicular head. More commonly seen in adolescents and children.

References

• Brower AC, Sweet DE, Keats TE. Condensing osteitis of the clavicle: a new entity. Am J Roentgenol Radium Ther Nucl Med. 1974 May;121(1):17-21.
• Abdelwahab IF, Hermann G, Ramos R, Klein MJ, Kenan S, Lewis MM. Case report 623. Osteitis condensans of the left clavicle (OCC). Skeletal Radiol. 1990;19(5):387-9.
• Harden SP, Argent JD, Blaquiere RM. Painful sclerosis of the medial end of the clavicle. Clin Radiol. 2004 Nov;59(11):992-9.
• Keats TE and Anderson MW. Atlas of Normal Roentgen Variants That May Simulate Disease. 8th edition, page 452; Mosby (2004).