Septic Arthritis of the Manubriosternal Joint (2022)


Corporate sign inSign in / register


  • Access throughyour institution

The Annals of Thoracic Surgery

Volume 83, Issue 3,

March 2007

, Pages 1190-1194

Pyarthrosis of the manubriosternal joint is exceedingly rare. Its rarity defies an early diagnosis, and other causes of chest pain would normally be ruled out first. We describe a patient with a short history of chest pain, pyrexia, and raised inflammatory markers. A destroyed manubriosternal joint with a large abscess was found during surgical exploration. This case illustrates an unusually rapid development of septic arthritis involving a fibrocartilaginous joint in an otherwise healthy young man. Nine other cases have been described in the literature and are reviewed. Early diagnosis followed by adequate surgical drainage and antibiotic therapy led to a good outcome.

Section snippets

Epidemiology and Clinical Features

Septic arthritis of the manubriosternal joint is rare [1, 2, 3, 4, 5, 6, 7, 8, 9] (Table 1), and its occurrence in an otherwise healthy adult is unusual. It is more common in men (70%). The median age of presentation is 42.5 (range, 20 to 75; mean, 44.7). Predisposing factors are seen in 50% of the cases. Risk factors include intravenous drug abuse, immunosuppressive drugs, inflammatory joint disease, and primary source of infection elsewhere [3, 4, 5, 8, 9].

The clinical course can be acute

References (11)

There are more references available in the full text version of this article.

Cited by (7)

  • Primary septic arthritis of the manubriosternal joint in an immunocompetent young patient: A case report

    2017, Radiology Case Reports

    (Video) Sternum and Sternoclavicular Joints - Wilfred Manzano MD

    Arthritides that may affect this joint include osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriasis, gout, calcium pyrophosphate deposition disease, and septic arthritis [1]. The latter is rarely encountered as a primary process, and this occurrence in an otherwise healthy adult is even more unusual [2]. Because of the rarity of this condition, little is known about its pathogenesis.

    The aim of this article was to illustrate a case of primary septic arthritis of the manubriosternal joint, due to Staphylococcus aureus infection, in an immunocompetent 28-year-old male patient. The manubriosternal joint can be rarely involved in inflammatory processes, but pyarthrosis is even more unusual in an otherwise healthy adult. Although rare, pyarthrosis could be associated with significant morbidity and mortality, first of all because of spreading to mediastinal structures. Diagnosis is generally made thanks to imaging findings after clinical suspicion in a patient with anterior chest pain and swelling, fever, and raised inflammatory markers, especially when any risk factors are known. Management is generally aggressive because intravenous antibiotics and surgical debridement are necessary.

  • Tuberculosis of the manubriosternal joint and concurrent asymptomatic active pulmonary tuberculosis in a patient presenting with a chest wall mass

    2015, Clinical Imaging

    The case presented is, to the best of our knowledge, the first one to describe the clinical and imaging (CT, MR imaging, bone scintigraphy) findings of a tuberculous manubriosternal joint septic arthritis. There is a rather recent review of nine cases of septic arthritis of the manubriosternal joint [1], but none of the cases was secondary to a M. tuberculosis infection. In addition, the case presented was an otherwise healthy woman (70% of the cases of manubriosternal septic arthritis occur in men) without known risk factors.

    A 62-year-old woman presented to our hospital with an anterior chest wall swelling. Computed tomography (CT) and magnetic resonance imaging showed findings consistent with an infectious arthritis of the manubriosternal joint, and CT images also demonstrated multiple centrilobular nodules in both lungs, suggesting an infectious bronchiolitis. A CT-guided fine needle aspiration of a presternal mass yielded growth of Mycobacterium tuberculosis. Bronchoalveolar lavage confirmed an active pulmonary tuberculosis. Septic arthritis of the manubriosternal joint is exceedingly rare.

  • An atypical cause of atypical chest pain

    2014, Canadian Journal of Infectious Diseases and Medical Microbiology

View all citing articles on Scopus

Recommended articles (6)

  • Research article

    Unexpected effects in non crystalline materials exposed to X-ray radiation

    Journal of Non-Crystalline Solids, Volume 451, 2016, pp. 153-160

    The interaction of high intensity synchrotron radiation X-rays in the energy range 5<E<30keV with matter can produce a large number of expected and less expected effects. Whether these be considered radiation damage or are simply ignored, perhaps depends on the context or the eye of the beholder. In many cases however, X-ray induced effects can easily be mistaken for experimental results, and non-crystalline materials and liquids are most affected. We give a brief overview of possible X-ray induced effects, including structural changes and nanoparticle formation in glass, reaction rates in catalysis, the formation of bubbles in aqueous environments due to the presence of salts, and discuss possible mechanisms. The results shown are relevant for time-resolved processes studied by X-ray methods in catalysis, glass devitrification and for liquid samples.

  • Research article

    Social Media in the Emergency Medicine Residency Curriculum: Social Media Responses to the Residents’ Perspective Article

    Annals of Emergency Medicine, Volume 65, Issue 5, 2015, pp. 573-583

    In July to August 2014, Annals of Emergency Medicine continued a collaboration with an academic Web site, Academic Life in Emergency Medicine (ALiEM), to host an online discussion session featuring the 2014 Annals Residents’ Perspective article “Integration of Social Media in Emergency Medicine Residency Curriculum” by Scott etal. The objective was to describe a 14-day worldwide clinician dialogue about evidence, opinions, and early relevant innovations revolving around the featured article and made possible by the immediacy of social media technologies. Six online facilitators hosted the multimodal discussion on the ALiEM Web site, Twitter, and YouTube, which featured 3 preselected questions. Engagement was tracked through various Web analytic tools, and themes were identified by content curation. The dialogue resulted in 1,222 unique page views from 325 cities in 32 countries on the ALiEM Web site, 569,403 Twitter impressions, and 120 views of the video interview with the authors. Five major themes we identified in the discussion included curriculum design, pedagogy, and learning theory; digital curation skills of the 21st-century emergency medicine practitioner; engagement challenges; proposed solutions; and best practice examples. The immediacy of social media technologies provides clinicians the unique opportunity to engage a worldwide audience within a relatively short time frame.

  • Research article

    The burden of gunshot wounding of UK military personnel in Iraq and Afghanistan from 2003–14

    Injury, Volume 49, Issue 6, 2018, pp. 1064-1069

    Gunshot wounding (GSW) is the second most common mechanism of injury in warfare after explosive injury. The aim of this study was to define the clinical burden of GSW placed on UK forces throughout the recent Iraq and Afghanistan conflicts.

    This study was a retrospective review of data from the UK Military Joint Theatre Trauma Registry (JTTR). A JTTR search identified records within the 12 year period of conflict between 19 Mar 2003 and 27 Oct 2014 of all UK military GSW casualties sustained during the complete timelines of both conflicts. Included cases had their clinical timelines and treatment further examined from time of injury up until discharge from hospital or death.

    (Video) Sterno-clavicular Joint (SCJ) Osteomyelitis

    There were 723 casualties identified (177 fatalities, 546 survivors). Median age at the time of injury was 24 years (range 18–46 years), with 99.6% of casualties being male. Most common anatomical locations for injury were the extremities, with 52% of all casualties sustaining extremity GSW, followed by 16% GSW to the head, 15% to the thorax, and 7% to the abdomen. In survivors, the rate of extremity injury was higher at 69%, with head, thorax and abdomen injuries relatively lower at 5%, 11% and 6% respectively. All GSW casualties had a total of 2827 separate injuries catalogued. A total of 545 casualties (523 survivors, 22 fatalities) underwent 2357 recorded surgical procedures, which were carried out over 1455 surgical episodes between admission to a deployed medical facility and subsequent transfer to the Royal Centre for Defence Medicine (RCDM) in the UK. This gave a median of 3 (IQR 2–5) surgical procedures within a median of 2 (IQR 2–3) surgical episodes per casualty. Casualties had a combined length of stay (LoS) of 25 years within a medical facility, with a mean LoS in a deployed facility of 1.9 days and 14 days in RCDM.

    These findings define the massive burden of injury associated with battlefield GSW and underscore the need for further research to both reduce wound incidence and severity of these complex injuries.

  • Research article

    Intentional Overdose With Tinzaparin: Management Dilemmas

    The Journal of Emergency Medicine, Volume 46, Issue 2, 2014, pp. 197-201

    Low-molecular-weight heparin (LMWH) is increasingly being prescribed for prophylaxis and treatment of thromboembolic diseases. Despite the fact that its therapeutic use is considered to be safe, it can be complicated by major hemorrhage and, in contrast to unfractionated heparin, it can only partially be neutralized by protamine. Recent reports of LMWH overdose illustrate the need for a consensus on its management.

    To describe a case of self-poisoning with a very large dose of tinzaparin and discuss management options in patients with LMWH overdose.

    A 69-year-old woman was brought to the Emergency Department 2 h after injecting herself with 280,000 IU of tinzaparin subcutaneously in an attempt to commit suicide. Despite an unrecordable activated partial thromboplastin time (APTT > 180 s) and prolonged prothrombin time, there was no evidence of active bleeding. She was given an intravenous infusion of 100 mg protamine sulfate and was admitted to the intensive care unit, where further infusions of protamine were administered. Normalization of the APTT occurred 40–50 h post admission, reflecting normal tinzaparin clearance rather than neutralization by protamine. No hemorrhagic complications occurred during her hospitalization except for prolonged bleeding from venipuncture sites.

    In this case of massive tinzaparin overdose, conventional doses of protamine failed to rapidly normalize the deranged coagulation parameters. The favorable clinical outcome suggests that, regardless of the LMWH amount injected, no active treatment is needed in the absence of hemorrhage. This is in accordance with the limited published data concerning cases of overdose with other LMWHs.

  • Research article

    Pediatric firearm injuries: Anatomy of an epidemic

    Surgery, Volume 168, Issue 3, 2020, pp. 381-384

  • Research article

    Digital morphometric analysis of Upper Palaeolithic beads: Assessing artifact variability with user-friendly freeware

    Journal of Archaeological Science: Reports, Volume 10, 2016, pp. 893-902

    Based on a case study of over 400 basket-shaped beads from Early Upper Palaeolithic (Aurignacian) deposits at four sites in the Aquitaine region of France, this article presents the results of morphometric analysis based on digital photographs using a freeware program developed in the biological sciences. The program, Tomato Analyzer 3.0 presents a number of advantages in terms of portability, cost, efficiency, and ease-of-use. Adapting the program to the analysis of archaeological artifacts does require some modifications to the original protocol, which are described in this article. The morphological attributes assessed by the program are presented, as are the preliminary results of the case study. The ability of the program to quantify artifact color is briefly introduced, as is the potential applicability of the program to the study of other artifact-types.

View full text

Copyright © 2007 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.


What is the significance of the Manubriosternal joint? ›

This joint allows a small amount of angulation between the longitudinal axes of the two sternal parts. This movement increases slightly the anteroposterior diameter of the thoracic cage facilitating the act of inspiration.

Which rib attaches to the Manubriosternal joint? ›

This is where the 2nd rib joins with the sternum. A clinically useful feature of the (manubriosternal) joint is that it can be palpated easily. This is because the manubrium normally angles posteriorly on the body of the sternum, forming a raised feature referred to as the sternal angle.

Is Manubriosternal joint synovial? ›

In adult pigs, bovis, sheeps, and some goats species, the joint between the manubrium and the body of sternum is a synovial joint called the synovial manubriosternal joint (by opposite to the cartilaginous joint called the manubriosternal synchondrosis).

At what age does the Manubriosternal joint fuse? ›

The average age of those showing an almost fused joint was 55-5 years. The average age of those showing complete fusion of the manubrio- sternal joint was 60. The youngest case showing complete fusion was 25, and there were several cases in the fourth decade.

What type of joint is Manubriosternal? ›

The manubriosternal joint is a cartilaginous joint (symphysis) where only a thin layer of hyaline cartilage covers the articular surfaces with an intervening fibrocartilage disc.

What type of bone is the manubrium? ›

Manubrium. The manubrium is a large quadrangular shaped bone that lies above the body of the sternum. The lower border is narrower, is quite rough, and articulates with the body with a thin layer of cartilage in between.

What is the size of the manubrium? ›

Its average length in the adult is about 17 cm., and is rather greater in the male than in the female. Manubrium (manubrium sterni). —The manubrium is of a somewhat quadrangular form, broad and thick above, narrow below at its junction with the body. Surfaces.

Is the Manubriosternal joint movable? ›

A synarthrosis is an immobile or nearly immobile joint. An example is the manubriosternal joint or the joints between the skull bones surrounding the brain. An amphiarthrosis is a slightly moveable joint, such as the pubic symphysis or an intervertebral cartilaginous joint.

Can arthritis in the shoulder cause chest pain? ›

Can shoulder arthritis cause neck or chest pain? If you have rheumatoid arthritis, you may experience pain in your neck and chest as a result of your arthritis. When chest pain occurs as a result of rheumatoid arthritis, it is called costochondritis, a condition that is often mistaken for a heart attack.

Can arthritis cause severe chest pain? ›

Chest and Rib Pain

It doesn't happen often, but chest pain and shortness of breath can be symptoms of psoriatic arthritis. These might happen when the chest wall and the cartilage that links your ribs to your breastbone get inflamed.

Is the manubrium bone or cartilage? ›

It connects to the ribs via cartilage and forms the front of the rib cage, thus helping to protect the heart, lungs, and major blood vessels from injury. Shaped roughly like a necktie, it is one of the largest and longest flat bones of the body. Its three regions are the manubrium, the body, and the xiphoid process.

Where is the manubrium bone located? ›

Manubrium. This is the top part of your sternum. Your collarbone and your first set of ribs connect here. The bottom of the manubrium shares a border with the body of the sternum.

What vertebral level is the Manubriosternal joint? ›

The manubriosternal joint is at the level of the lower border of the body of the fourth thoracic vertebra and the xiphisternal joint at the level of the ninth. The xiphisternum is of variable length and covered by the attachments of the rectus muscles.

What is the complete classification of the joint between the manubrium and the first rib? ›

The first sternocostal joint is a synchondrosis type of cartilaginous joint in which hyaline cartilage unites the first rib to the manubrium of the sternum. This forms an immobile (synarthrosis) type of joint.

Where are synchondrosis joints found? ›

A synchondrosis is a cartilaginous joint where the bones are joined by hyaline cartilage. Also classified as a synchondrosis are places where bone is united to a cartilage structure, such as between the anterior end of a rib and the costal cartilage of the thoracic cage.

Is the Manubriosternal joint a symphysis? ›

Conclusion: The manubriosternal joint is classified as symphysis and the main age-related changes is the relative thickness of the tissue.

What are the 3 types of joints in the body? ›

Histologically the three joints in the body are fibrous, cartilaginous, and synovial. Functionally the three types of joints are synarthrosis (immovable), amphiarthrosis (slightly moveable), and diarthrosis (freely moveable).

What is manubrium definition? ›

Definition of manubrium

: an anatomical process or part shaped like a handle: such as. a : the uppermost segment of the sternum of humans and many other mammals. b : the process that bears the mouth of a hydrozoan : hypostome.

How many bones does the manubrium articulate with? ›

The clavicular notches of the sternum articulate with the medial end of each clavicle to form the sternoclavicular joints. The manubrium sterni also articulates with the costal cartilages of the 1st pair of ribs.

What is a manubrium fracture? ›

Transverse fractures of the manubrium sterni can occur after direct impact or indirect forces like a flexion/compression mechanism which is then often accompanied by additional vertebral fractures known as sternovertebral-injury with a posterior displacement of the manubrium (9,11-14).

Is manubrium a flat bone? ›

The appearance of the manubrium has been described as trapezoidal, a necktie or even a handle. It is a four-sided, flat bone and is broad superiorly. Its width tapers down inferiorly. The concave superior border is called the jugular or suprasternal notch.

Can you live without a sternum? ›

Removal of the sternum creates some instability to the rib cage, but most patients do well without an intact sternum. It does, however, create a large space which the overlying skin alone cannot close. The body will fill any such empty space, called dead space, with clotted blood, serum or lymph.

What organ is under your sternum? ›

The thymus is a small organ located just behind the breast bone (sternum) in the front part of the chest.

Where is the Manubriosternal joint? ›

The manubriosternal joint is the articulation between the manubrium and the body of sternum [1, 2].

Why is the sternal angle an important landmark? ›

The sternal angle is an important clinical landmark for identifying many other anatomical points: It marks the point at which the costal cartilages of the second rib articulate with the sternum. This is particularly useful when counting ribs to identify landmarks as rib one is often impalpable.

What vertebral level is the Manubriosternal joint? ›

The manubriosternal joint is at the level of the lower border of the body of the fourth thoracic vertebra and the xiphisternal joint at the level of the ninth. The xiphisternum is of variable length and covered by the attachments of the rectus muscles.

Septic arthritis is the inflammation sequency that comes after a pathogenic agent enters the steril cavity of the joint.

Risk factors The very first step is to identify those patients who might be at risk of presenting with a setic arthritis, and it is very useful when we have limited access to specific laboratory tests.. Fever : not all patients present fever, so that the lack of it does not rule the diagnosis of septic arthritis out.. You can find the complete clinical case here .This elder patient, diabetic, with osteoarthritis, presented with a late shoulder septic arthritis.. Lab Test Without doubt there is a lot of information everywhere about lab tests for septic arthritis diagnosis.. Leukocyte count (synovial) : Synovial, not serum (blood) leukocyte count, by JOINT ASPIRATION, gets high.. A lab test, ideally, must be 100% sensible and specific, this means, all labeled patients as healthy are actually healty, and all diagnosed with the disease are sick.. If we use the 50,000 synovial leukocyte limit, it means that we can have a sick patient with a lab test result of 38,000, labeled as healthy, and consequently would not recieve early treatment.. Diagnostic utility of laboratory tests in septic arthritis.. Even if it is negative and a septic arthritis is highly suspected, perform an arthrotomy/arthroscopy and a joint lavage.. Shoulder septic arthritis is dangerous, patient might die.. So, if your patient meets risk factors (old, ostearthritis, acute pain, CPR elevated, diabetic, etc) it is always a good idea to aspirate the joint.. If joint fluids comming from drain, are not red clear, but instead they are mucoid/darkbrown/fetid, or CPR does not decreases, patient might have a bigger undetected problem, like a deep abscess or a disecant infection.

Septic arthritis is an infection in a joint. Symptoms include pain and tenderness over a joint, pain on moving the joint, and feeling unwell.

Septic arthritis is an infection in a joint.. Symptoms include pain and tenderness over a joint, pain on moving the joint, and feeling unwell.. This includes antibiotic medicines and drainage of infected fluid from the joint to prevent permanent joint damage.. If some germs (bacteria) settle on a small section of a joint, they can multiply and cause infection.. Bacteria can get into a joint if you have a wound that cuts into a joint.. Infection is an uncommon complication if you have joint surgery or joint investigations (such as arthroscopy ).. However, in about 1 in 5 cases the germs (bacteria) from one joint spread in the blood to another and two or more joints may be affected at the same time.. The blood often contains some bacteria from the infected joint.. This is to make sure all infection has gone from the joint.. Infected fluid is drained from the affected joint.. This helps to stop damage to the joint while the antibiotics clear the infection.. However, deeper joints such as a hip joint are more difficult and may need a small operation to drain the infected fluid.. Once the infection has been treated and when symptoms begin to settle it is important to get the affected joint moving again.. The most common artificial joints to become infected are elbow, shoulder and ankle joints, followed by knee and hip joints.

Septic arthritis is infection and inflammation of a joint caused by bacterial, fungal, or viral invasion of the synovium. Bacterial septic arthritis involves a single joint in 90% of cases. The knee is the most commonly involved joint, followed by the hip, shoulder, ankle, and wrist. Patients with septic arthritis typi- cally have acute swelling […]

Bacteria can reach a joint in four ways: (1) from the blood, that is, via hematogenous seeding during bacteremia;(2) from the out- side environment through direct inoculation of organisms following penetrating trauma, joint aspiration, or surgery;(3) from the localized spread of a nearby soft-tissue infection, such as cellulitis or bursitis; or (4) from spread of a bone infection near the joint (periarticular osteomyelitis).1 Hematogenous seeding is the most common cause of infectious arthritis.. While neutrophils are one of the primary host defenses against joint infection, they also are a major cause of joint destruction in septic arthritis.. Disseminated gonococcal infection, classically associated with a syndrome of fever, chills, rash, and migratory arthritis of the large joints, always precedes gonococcal septic arthritis, nor- mally involving a single joint.. Although gonococcal septic arthritis is always preceded by systemic gonococcal infection, this stage may go unnoticed in up to 30% of patients.7 Gono- coccal infection is the most common type of infectious arthritis in healthy adults.. Some patients with inflammatory arthritis but no infection may have more than 50,000 white blood cells per milliliter, whereas some patients with infection and immune suppression (which limits white cell production) may have less.. Conditions to consider include inflammatory arthritis, reactive arthritis (a noninfectious joint inflammation following infection else- where in the body), trauma, superficial infection or abscess near but not in the joint, and collagen vascular disorders.. The goals of treatment include sterilization of the joint, removal of inflammatory cells and their enzymes, elimination of the destructive synovial pannus, and restoration of function.1 Prompt administration of antibiotics and drain- age of the involved joint can prevent cartilage destruction, minimizing the risk of secondary arthritis, joint instability, deformity, and loss of function.


1. NEXT MEDICO 2022 - MBBS - HUMAN ANATOMY - Lecture - 3 (Joints)
(Next Medico MBBS Classes by Biomentors)
2. Rheumatoid Arthritis
(Axis Medical School)
3. CC R1: That's All Folks, Part 1
(The Clinical Correlation)
4. Initial Evaluation of A Child with Arthritis by Dr. dr. Wisnu Barlianto, M.Si.Med., SpA(K)
(Departemen IKA FKUB RSSA)
5. Osteoarthritis in Hindi | arthritis symptoms treatment cure
(Shomu's Biology)
6. Open Reduction and Ligament Reconstruction of Locked Anterior Inferior SCJ Dislocation

You might also like

Latest Posts

Article information

Author: Moshe Kshlerin

Last Updated: 08/06/2022

Views: 6496

Rating: 4.7 / 5 (57 voted)

Reviews: 80% of readers found this page helpful

Author information

Name: Moshe Kshlerin

Birthday: 1994-01-25

Address: Suite 609 315 Lupita Unions, Ronnieburgh, MI 62697

Phone: +2424755286529

Job: District Education Designer

Hobby: Yoga, Gunsmithing, Singing, 3D printing, Nordic skating, Soapmaking, Juggling

Introduction: My name is Moshe Kshlerin, I am a gleaming, attractive, outstanding, pleasant, delightful, outstanding, famous person who loves writing and wants to share my knowledge and understanding with you.