Conservative Management of Condensing Osteitis of the Medial End of the Clavicle

Young-Kyu Kim; Dong-Wook Kim; Dong-Whan Kim

doi:10.4055/jkoa.2010.45.3.173

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Kim, Kim, and Kim: Conservative Management of Condensing Osteitis of the Medial End of the Clavicle

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2010; 45(3): 173-178.

Published online: 9 June 2010

DOI: https://doi.org/10.4055/jkoa.2010.45.3.173

Conservative Management of Condensing Osteitis of the Medial End of the Clavicle

Young-Kyu Kim, M.D., Dong-Wook Kim, M.D., Dong-Whan Kim, M.D.

Department of Orthopedic Surgery, Gachon University of Medicine and Science, Gil Hospital, Incheon, Korea.

Correspondence to: Dong-Wook Kim, M.D. Department of Orthopedic Surgery, Gachon University of Medicine and Science, Gil Hospital, 1198, Guwol-dong, Namdong-gu, Incheon 405-760, Korea. TEL: +82-32-460-3384, FAX: +82-32-468-5437, okspirit@hanmail.net

Received 24 November 2009 Accepted 15 April 2010

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To assess the clinical features and the outcomes of conservative treatment of condensing osteitis of the medial end of the clavicle.

Materials and Methods

We reviewed 24 patients among 44 patients with pain and protrusion on the medial clavicle, who were diagnosed as condensing osteitis and followed over one year between April 2003 and August 2008. Plain radiograph and laboratory examination (24 cases), bone scan (12 cases), computed tomography (3 cases), MRI (1 case) and biopsy (1 case) were performed. Patients were followed with UCLA score, VAS (Visual Analogue Scale) and change of protrusion.

Results

In all cases, mild sclerosis and expansion were seen at the medial clavicle and sternoclavicular joint was preserved. Laboratory examination showed nonspecific results but various abnormal findings. Protrusion was not changed in 20 cases (83%) and decreased in 4 cases (17%). VAS for pain was improved from 3.4 to 1.2 and VAS for function was improved from 25.5 to 29.1. UCLA score was improved from 28.8 points to 33.7 points.

Conclusion

Physical and radiologic examination was important for diagnosis of condensing osteitis and laboratory exmination was useful to differentiate it from other diseases. Conservative treatment with rest and nonsteroidal anti-inflammatory drugs showed satisfactory result.

Keywords: medial clavicle, condensing osteitis, clinical feature, conservative treatment

Figures and Tables

Figure 1

Condensing osteitis of clavicle. (A) 57-year-old woman had pain in right medial clavicular region. Photograph shows swelling of sternal end of right clavicle. (B) Plain radiograph shows a sclerotic and irregular lesion in inferior aspect of right clavicular head (white arrow). (C) CT scan shows soft tissue swelling adjacent to it anteriorly (white arrow). (D) Scintigram shows increased uptake of tracer localized to sternal end of right clavicle.

Figure 2

Protrusion of medial clavicle in condensing osteitis. (A) 52-year-old woman who was diagnosed to condensing osteitis shows protrusion of right medial clavicle. (B) After 4 years, photography shows no change of protrusion.

Figure 3

Histopathology of condensing osteitis. (A) High power photomicrograph shows marrow fibrosis. (B) High power photomicrograph shows trabecular sclerosis and arcuate cement lines of mature, lamellar bone (H&E, ×200).

Table 1

Characteristics of Patients Diagnosed to Condensing Osteitis

D/ND, dominant/non-dominant; Sx, symptom; CBA, cross body adduction.

Table 2

Clinical, Scintigraphic and Hematologic Findings in Cases of Condensing Osteitis of the Clavicle

ESR, erythrocyte sedimentation rate; ANA, anti-nuclear antibody; ND, not done; RA, rheumatoid factor

Table 3

Initial and Follow-up Clinical and Functional Outcomes

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