Stress fracture of the clavicle associated with sternocostoclavicular hyperostosis combined with bony ankylosis of the acromioclavicular joint and ossification of the coracoclavicular ligament.

Sternocostoclavicular hyperostosis (SCCH) has been reported in patients with pustulotic arthro-osteitis, but there are few reports of marked ossification of the lateral part of the clavicle. Here, we report a case of stress fracture in a patient with SCCH with marked ossification of the lateral part of the clavicle. In this case, the clavicular fracture was proximal and no dislocation. Conservative treatment with a clavicle band and the administration of corticosteroids resulted in rapid symptom improvement. Eight months later, the patient had no difficulty in daily life, but X-rays showed that bone fusion was not complete. Therefore, it is necessary to carefully follow-up such patients for any recurrence of symptoms and radiographic changes.

[Sapho syndrome: 2 case reports]. / Das Sapho-Syndrom: Zwei Fallbeschreibungen.

We report on two patients with painful hyperostosis of the mandible and the thoracic skeleton. Other symptoms were arthralgia, arthritis, osteitis, and palmoplantar pustulosis. Radiographic analysis revealed regions of circumscribed hyperostosis which showed in increased uptake in scintiscan. Metastasis, chronic osteomyelitis, Ewing's sarcoma, or Paget's disease were excluded and the diagnosis Sapho syndrome was made. This recently introduced acronym describes a disease with Synovitis, Acne, Pustulosis, Hyperostosis and Osteitis. Because of the possible axial skeleton involvement, an association to the spondylathropathy group is still being discussed. The etiopathogenesis of this rheumatologic disease is not known.

[Acquired hyperostosis syndrome (so-called pustular arthro-osteitis). Review of the literature including 73 personal cases]. / Akquiriertes Hyperostose-Syndrom (sogenannte pustulöse Arthroosteitis). Literaturübersicht einschliesslich 73 eigener Beobachtungen.

The acquired hyperostosis syndrome (AHS) (best known synonym: pustulotic arthro-osteitis) is a system disease of the supporting and gliding tissue with sites of predilection characterized by inflammation-induced bony reconstruction of positive balance. This syndrome is affiliated with the seronegative spondylarthropathies. The main finding is the sternocostoclavicular hyperostosis in about 80% of patients. Focal hyperostoses also occur on the skeleton of truncus and extremities and joints. AHS is accompanied by psoriasiform and acneform dermatoses. Overlapping findings with spondylitis ankylosans are reported. Terminology, aetiology, nosology, pathogenesis, histomorphology, clinical and laboratory findings, complications, imaging diagnostic, differential diagnosis and therapy of AHS are discussed. Knowing AHS helps to prevent misdiagnoses (as especially bacterial osteomyelitis, spondylitis, osteoplastic tumor and metastases) and interventional diagnostic procedures.

Sternocostoclavicular hyperostosis. Presentation and long-term follow-up of three cases.

Sternocostoclavicular hyperostosis is a rare disease characterized by recurrent pain and skeletal swelling in the upper part of the chest. The clinical manifestations are closely linked to pustulosis palmo-plantaris but the etiology is still obscure. We present three cases of sternocostoclavicular hyperostosis with a follow-up period of 9-22 years at our department.

Sternoclavicular joint swellings: diagnosis and management.

Five patients with sternoclavicular swellings are described. The group presents a variety of diagnoses which highlight the need for thorough investigation and appropriate management of swellings around the sternoclavicular joint. Although frequently assumed to be benign, this series demonstrates the potential occurrence of malignant disease, and the dangers of pursuing a simple conservative course. Conversely, a substantiated benign diagnosis may avoid the use of unnecessary surgical treatment.

[Sternocostoclavicular hyperostosis]. / Hyperostosis sternocostoclavicularis.

On the basis of 4 patients from our own records we describe the rare syndrome of "Hyperostosis sternocostoclavicularis". The etiology of this disorder is still unclarified. In addition to a swelling that is generally only slightly tender to pressure, the most important symptom is usually a long-standing, intermittent, dull pain in the upper sternum, the claviculae and the adjacent uppermost ribs. Laboratory diagnosis usually shows an accelerated blood sedimentation rate, but other laboratory findings are unremarkable and rheumatological serology gives a negative result. The changes detected by radiography are described, as are the histological findings. Primary or secondary malignant osteomas are also to be taken into account in differential diagnosis. For therapy most authors recommend medicinal treatment with non-steroidal antiphlogistic agents.

Three cases of inter-sterno-costo-clavicular ossification associated with tonsillar infection.

Three cases of inter-sterno-costo-clavicular ossification (ISCCO) associated with chronic tonsillitis are reported. Two cases had additional symptoms of pustulosis palmaris et plantaris (PPP). All the patients underwent tonsillectomy. The histological changes of the palatine tonsils of case 1 and case 2 were characterized by so-called focal small lacunar ulcers and periarteriolar fibrosis (onion-skin lesion). Some multinucleated giant cells were observed in case 2. Following tonsillectomy, symptoms in the clavicular region and the PPP improved. It is possible to consider that ISCCO is caused by focal tonsillar infection.