Anatomical and functional features of the clavicle joints. Characteristics of clavicle dislocations. Sternoclavicular joint: structure

Clavicle, clavicula, is the only bone that connects the upper limb to the skeleton of the body. Functional meaning it is large: it sets the shoulder joint at the proper distance from chest, causing greater freedom of movement of the limb. When comparing the clavicle various forms hominids it is clear that it gradually increases in modern man becomes the most developed, which is associated with progressive work activity. It is a covering bone that has moved to the body, therefore it ossifies partly on the basis of connective tissue (its middle part), partly on the basis of cartilage (ends), while an independent point of ossification is formed only on one (sternal) epiphysis (monoepiphyseal bone).

The clavicle ossifies both peri- and endochondral. According to the classification, the clavicle belongs to mixed bones and is divided into a body and two ends - medial and lateral. The thickened medial, or sternal, end, extremitas sternalis, bears a saddle-shaped articular surface for articulation with the sternum. The lateral, or acromial, end, extremitas acromialis, has a flat articular surface - the place of articulation with the acromion of the scapula. On its lower surface there is a tubercle, tuberculum conoideum (trace of ligament attachment). The body of the clavicle is curved in such a way that its medial part, closest to the sternum, convexes anteriorly, and the lateral part posteriorly.

Ossification. The clavicle receives a point of ossification earlier than all other bones - at the 6th week of intrauterine development. At the 16-18th year, a bone core appears at the sternal end (epiphysis), which merges at the 20-25th year. Therefore, on radiographs of the belt upper limb In people aged 16 to 25 years, multiple islands of ossification can be found at the sternal end of the clavicle, which, merging, turn into a flat disc. In an adult, the anterior radiograph clearly shows the entire clavicle as slightly curved in an S-shape. On the lower surface of the clavicle, above the processus coracoideus of the scapula, a tuberculum conoideum is often noticeable, which can simulate inflammation of the periosteum in this area of ​​the clavicle.

Which doctors should I contact to examine the Clavicle:

Traumatologist

What diseases are associated with the collarbone:

What tests and diagnostics need to be done for the collarbone:

Chest X-ray

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Other anatomical terms starting with the letter "K":

The clavicle is a paired bone, small in size, located above the first rib, shaped like an elongated Latin letter “S”. The clavicle has sternal and acromial ends, as well as a body (diaphysis). It forms the girdle of the upper limb, connecting at the sternal end with breastbone(sternum) and acromial end (blade) with the scapula in the acromioclavicular joint.

Functions collarbone:
Supporting – a shovel and an upper limb are suspended from it. The collarbone connects the body and the arm, providing it with maximum mobility;
Takes part in the transmission of physical impulses from the hand to the axial skeleton;
Protects important structures (blood vessels, lymphatic vessels, nerves) located between the arm and neck.

Embryonic development of the clavicle

Clavicle diseases

Dislocation of the acromioclavicular joint.
Causes of dislocation: falling on the shoulder joint. At the time of injury, the scapula is torn away from the collarbone, resulting in dislocation of its acromial end.
Symptoms:
The upper limb is noticeably lengthened;
Immediately after the injury, before the development of edema, a deformation in the area of ​​the acromioclavicular joint, resembling a step, is noticeable;
A typical “key” symptom is when pressing on the area of ​​the acromioclavicular joint, the end of the clavicle is reduced and it returns to the pathological position after the pressure stops.

Osteolysis of the clavicle.
Osteolysis - rare pathology associated with resorption of the bone tissue of the clavicle. The causes of the disease have not been fully elucidated. They are known to be closely associated with autoimmunization of bone tissue. It is curious that with this disease the collarbone does not hurt. Clinically, osteolysis is manifested by fractures that heal very poorly. X-rays clearly show loss of bone tissue (osteoporosis).

Is a clavicle transplant possible?

Diagnosis of clavicle injuries

Treatment and prevention

An operation accompanied by the combination of bone fragments is called osteosynthesis. During this procedure, the doctor restores the bones, fixing them with a special plate and screw. Sometimes, in case of fractures, a pin is installed that holds the collarbone in the correct position.

Primary prevention of clavicle injuries is largely related to injury prevention. Secondary prevention late complications, for example, malunion of the clavicle with subsequent deformation of the shoulder girdle, consists of early seeking qualified help from a traumatologist immediately after the injury.

The clavicle is the only bone that connects the girdle of the upper limb with the bones of the torso. Its sternal end is inserted into the clavicular notch of the sternum, forming the articulatio sternoclavicularis, and has a saddle shape (Fig. 121). Thanks to the discus articularis, which represents the transformed os episternale of lower animals, a spherical joint is formed. The joint is strengthened by four ligaments: the interclavicular ligament (lig. interclaviculare) is located above - it passes over the jugular notch between the sternal ends of the clavicle; below, the costoclavicular ligament (lig. costoclaviculare) is better developed than others. It starts from the collarbone and attaches to the 1st rib. There are also anterior and posterior sternoclavicular ligaments (ligg. sternoclavicularia anterius et posterius). When the belt of the upper limb is displaced, movements are carried out in this joint: along vertical axis- forward and backward, around the sagittal axis - up and down. Rotation of the clavicle around the frontal axis is possible. When all movements are combined, the acromial end of the clavicle describes a circle.

121. Connection of the sternal end of the clavicle. 1 - sternoclavicular ligament; 2 - interclavicular ligament; 3 - disc in the sternoclavicular joint; 4 - clavicular-costal ligament; 5 - sternocostal joint; 6 - sternum.

The acromioclavicular joint (articulatio acromioclavicularis) connects the acromial end of the clavicle to the acromion of the scapula, forming a flat joint (Fig. 122). A disc is very rarely found in a joint (1% of cases). The joint is strengthened by lig. acromioclaviculare, which is located on top surface collarbone and spreads to the acromion. The second ligament (lig. coracoacromiale), located between the acromial end of the clavicle and the base of the coracoid process, is located away from the joint and holds the clavicle to the scapula. Movements in the joint are insignificant. Displacement of the scapula causes displacement of the collarbone.

122. Ligaments of the acromial end of the clavicle (according to Kiss, Szentagotai). 1 - clavicula; 2 - lig. coracoacromiale; 3 - lig. trapezoideum; 4 - lig. conoidum; 5 - processus coracoideus; 6 - cavitas glenoidalis; 7 - tendo m. bicipitis brachii; 8 - acromion; 9 - lig. acromioclaviculare.

The ligaments of the scapula are not related to the joints and arise as a result of thickening of the connective tissue. The most well developed is the coracoacromial ligament (lig. coracoacromiale), dense, in the shape of an arch, into which the greater tubercle rests humerus when the arm is abducted more than 90°. The short superior transverse ligament of the scapula (lig. transversum scapulae superius) extends over the notch of the scapula and sometimes ossifies in old age. The suprascapular artery passes under this ligament.

(clavicula) - a tubular paired bone of the shoulder girdle, articulating with the sternum and scapula. Functionally, the K. belongs to the upper limb; anatomically, it serves as the border between the neck and torso.

Anatomy

K. has the shape of an elongated letter S (Fig. 1); the length of the adult human body is 12-15 cm. The medial part of the body (about 2/3 of the length) is curved anteriorly, the lateral third is curved posteriorly and ends with a plate of spongy structure, flattened from top to bottom. The middle section of the kidney is cylindrical in shape and has a bone marrow canal. The sternal end is thickened, has the shape of a triangular prism with blunt edges and a pronounced rough impression on bottom side, caused by the attachment of the costoclavicular ligament. On the lower side of the acromial end of the cone there is a cone-shaped tubercle (tuberculum conoideum) and a trapezoidal line (linea trapezoidea) - the attachment points of the coracoclavicular ligament. The deltoid muscle (m. deltoideus) is attached to the acromial end from above and in front, and the trapezius muscle (m. trapezius) from above and behind.

The acromial end of the joint articulates with the acromial process of the scapula, forming the acromial clavicular joint. Mobility in it is due to weak tension of the articular capsule and the fibrocartilaginous layer between the bones; the edges are often formed into a more or less isolated disc. The joint is strengthened by two ligaments: acromioclavicular (lig. acromioclaviculare) and coracoclavicular (lig. coracoclaviculare).

The sternal end of the joint articulates with the sternum (sternoclavicular joint). The joint is divided into two cavities by a cartilaginous articular disc. The stability of the joint is due to powerful ligaments. It is connected to the first rib by a two-layer costoclavicular ligament (lig. costoclaviculare). In front and behind, the sternoclavicular joint is strengthened by the anterior and posterior sternoclavicular ligaments (lig. sternoclaviculare ant. et post.). The interclavicular ligament (lig. interclaviculare) passes across the jugular notch.

The sternocleidomastoid muscle (m. sternocleidomastoideus) is attached to the sternal end of the muscle at its posterior edge, and the sternohyoid muscle (m. sternohyoideus) is attached below. The pectoralis major muscle (m. pectoralis major) is attached to the medial two-thirds of the chest in front. The subclavian muscle (m. subclavius) runs along the lower surface of the muscle between the first rib and its acromial end. The nutrient opening (foramen nutricium) is also located here, through which vessels penetrate into the bone.

The sternoclavicular and acromioclavicular joints are involved in active movements of the upper limb. With their participation, it rises above the horizontal line, moves forward and to the side. The functional significance of the shoulder is that it is a “spacer” between the bones of the torso (sternum) and the shoulder joint (see Shoulder girdle). This stabilizes the joint and increases its range of motion.

At the level of the middle third of the cartilage, behind it, between the attachment of the deltoid and large pectoral muscles, anterior to the first rib are the subclavian artery and vein and the brachial plexus.

Age characteristics K.: the first ossification nuclei appear in K.’s body at 5-6 weeks. intrauterine life and merge at the 7th week. The ossification nucleus in the cartilaginous sternal end of the cartilage appears at 16-20 years of age and merges with the body of the cartilage by 20-25 years.

X-ray anatomy

For X-ray examination of K., radiography is used in the anterior and posterior projections, sometimes in the anterior bilateral projection - to obtain a symmetrical image of both K., as well as in the so-called. upper projection- to obtain: images of K. outside the background of the ribs (when the rays move from below to the front, along the anterior wall of the chest). If there are indications, use: tomography (see). All pictures of K. are taken with held breathing.

In direct projection photographs, the S-shaped curvature of the knee in the horizontal plane is concealed (Fig. 2). The wide flat acromial end of the K. is projected against the background of thin integument and therefore appears sparse; it has a small articular surface. On the lower contour of the K., near the sternal end, a depression is visible at the site of attachment of the costoclavicular ligament, sometimes mistakenly taken for a focus of destruction. In the diaphysis of the K. the cortical layer and the medullary cavity are expressed, and at the ends there is a spongy structure and a thin cortical layer. Near upper contour In the diaphysis, sometimes there is an oblong clearing with a diameter of up to 3 mm - a canal for the lateral branch of the middle supraclavicular nerve.

Pathology

Congenital deformities

Congenital deformities are rare and are divided into two groups: 1) violations of the size and shape of the joint - additional coracoclavicular, costoclavicular joint, bifurcation of the joint; 2) so-called defective anomalies - absence of part or all of the K., perforated K., clavicular-cranial dysostosis (see).

For congenital deformities of the bone, in the case of functional disorders, surgical treatment (bone grafting) is indicated.

Damage

Dislocations of the acromial end of the shoulder are more common and usually occur when there is a blow to the acromial process of the scapula or a fall on the adducted shoulder; they can be incomplete (subluxations due to rupture or tear of one acromiocleidoclavicular ligament) and complete (if the coracoclavicular ligament is also ruptured). When the acromial end of the joint is dislocated, its protrusion is visible under the skin, and when pressure is applied from above, mobility is determined (“key symptom”). If a dislocation of the acromial end of the joint is suspected, bilateral photographs are taken (for comparison with the opposite side) with the patient in a vertical position, since in a horizontal position the displacement can be eliminated on its own. A radiograph showing dislocation or subluxation shows an upward displacement of the acromial end of the joint.

Dislocation of the sternal end of the K. can be incomplete (subluxation) or complete. There are presternal, suprasternal and retrosternal dislocations. These dislocations are difficult to diagnose, since the deformation is not significant, and on the anterior bilateral radiograph, the asymmetry of the sternal ends of the blood is revealed only with suprasternal dislocation.

To reduce dislocations of the acromial end of the joint, under local anesthesia, the shoulder is raised, pulled back and pressed from above on the outer end of the joint. To hold the joint in this position, there is large number plaster casts and splints, general principle which is pressure from above on the acromial end of the shoulder. Good results are achieved by using staged bandages of the “belt belt” type, the main advantage of which is constant pressure on the acromial end of the shoulder, the reliability of its immobilization and the possibility of early restoration of the function of the shoulder joint. The pressure element of these dressings is used in the first 3 weeks. replaceable plaster splint, and then rubber honey. bandage folded in several layers. Complete and chronic (3 weeks or more after injury) dislocations of the acromial end of the clavicle are usually treated surgically. Fixation of the joint to the acromial and coracoid processes using a silk thread has become widespread; a combined method is connecting the joint to the coracoid process with Mylar tape, to the acromial process with Kirschner wires, and osteosynthesis of the joint with metal clamps. After the operation they apply plaster cast type Deso with a roller in the armpit for 3-4 weeks. (see Desmurgy). With fresh dislocations of the sternal end of the joint, it is easy to perform a closed reduction, but it is extremely difficult to hold the reduced end of the joint. Therefore, open reduction of the dislocation with fixation with one or more wires is often performed. Immobilization after surgery - up to 6 weeks.

Clavicle fractures amount to approx. 3% of all fractures. Direct blows to the knee are relatively rarely the causes of fractures. The latter are most often caused by an indirect effect on the knee: a fall on an outstretched arm, a blow to the shoulder joint, compression of the body in the sagittal plane, etc.

The most common localization of K.'s fractures is the border of its middle and outer thirds, which is due to fiziol, its bending and the lowest mechanical strength in this place. In adults, fractures are transverse, oblique, comminuted, often with significant shift. In children, subperiosteal greenstick fractures are more common. Under the influence of muscle traction during a fracture of the joint, the lateral end of the eva moves downward and anteriorly, and the medial end moves upward and inward (Fig. 3). Occasionally, K.'s fractures are fraught with the danger of breaking the skin with a sharp fragment, injury to the subclavian vessels and parietal pleura.

K.'s fractures are characterized by all the classic signs of fractures (see): deformation in the form of swelling and often protrusion of the ends of fragments under the skin, subcutaneous hematoma, severe pain, palpation of bone fragments and their crepitus in the K. area, dysfunction of the corresponding upper limb. Shoulder joint on the side of the fracture, it is shifted downwards and slightly forward, the head is tilted towards the side of the injury. With subperiosteal fractures in children, symptoms are limited to swelling, pain on palpation and during movements of the upper limb. The X-ray image clearly shows the fracture line of the joint. In doubtful cases (for example, non-displaced fractures, “greenstick” fractures in children), an x-ray of both joints is needed on the same film.

K.'s combat injuries are accompanied by damage to the neurovascular formations, the lung, nearby large bones and a large mass of soft tissue (see Wounds, wounds) and in connection with this massive bleeding (see) and traumatic shock(see Shock).

Treatment of K.'s fractures can be conservative and surgical. The conservative method is used most often, especially in children.

For immediate reposition of a fracture, K., performed under local anesthesia with 2% novocaine solution (15-20 ml), the patient is seated on a stool, and an assistant with both hands, standing behind, spreads the patient’s shoulders so as to bring the inner edges of the shoulder blades closer together . The surgeon at this time thumb performs reposition of K. fragments with subsequent immobilization (see). Retention of fragments presents significant difficulties, which explains the existence of more than 250 various types bandages and splints for the treatment of K fractures. The most widely used are the Kuzminsky, Kaplan, Chaklin splints, the figure-of-eight bandage (Fig. 4), plaster casts such as Deso, Sitenko, etc. Consolidation of a K fracture in the vast majority of cases occurs with immobilization for 4- 6 weeks, often with some displacement of fragments. However, hand function is usually not affected. Non-union of a fracture is extremely rare; it is associated with significant interposition of soft tissues in the fracture zone or with gross errors in immobilization.

Indication for surgical treatment are only fractures with significant displacement of fragments and interposition of soft tissues, the threat of skin breakout by a fragment of K. and damage to blood vessels, false joints of K. with impaired limb function. Various options for intramedullary fixation of K fragments are used (Fig. 5). Regardless of the method of osteosynthesis (OS), after surgery a plaster cast is applied for 6-10 weeks, and sometimes for a longer period.

Diseases

Osteomyelitis (see) K. occurs more often in children, usually affecting the sternal end of the K. Surgical treatment -).

Tumors

The most common are sarcoma (see), osteoblastoclastoma (see), osteoma (see) and angioma (see). Treatment depends on the type and nature of the tumor.

Bibliography: Kaplan A. V. Closed injuries of bones and joints, M., 1967, bibliogr.; Krupko I. L. Guide to traumatology and orthopedics, book. 1, L., 1974, bibliogr.; Multi-volume guide to orthopedics and traumatology, ed. N. P. Novachenko, vol. 2, p. 480, vol. 3, p. 381, M., 1968; Nagy D. X-ray anatomy, trans. from Hungarian, p. 56, Budapest, 1961; ReinbergS. A. X-ray diagnosis of diseases of bones and joints, vol. 1-2, M., 1964; Watson-D JonesR. Bone fractures and joint damage, trans. from English, M., 1972; B u n n e 1 I S. Surgery of the hand, Montreal - Philadelphia, 1964; Herman S. Congenital bilateral pseudarthrosis of the clavicles, Clin. Orthop. related Res., No. 91, p. 162, 1973; Kohler A.u. Zimmer E. A. Grenzen des Normalen und Anfange des Pathologischen im Ront-genbilde des Skelettes, S. 168, Stuttgart, 1956; Sycamore L. K. Common congenital anomalies of bone thorax, Amer. J. Roentgenol., v. 51, p. 593, 1944.

E. P. Mattis; S. I. Finkelshtein (rent.).