Incisura Clavicularis – Anatomy and Clinical Relevance
The incisura clavicularis is a paired articular notch on the manubrium sterni that articulates with the medial end of the clavicle to form the sternoclavicular joint.
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The incisura clavicularis is a paired articular notch on the manubrium sterni that articulates with the medial end of the clavicle to form the sternoclavicular joint.
Definition
The incisura clavicularis (Latin: clavicular notch) is a paired, oval articular facet located on the upper lateral border of the manubrium sterni (the uppermost part of the sternum). Together with the medial end of the clavicle and a fibrocartilaginous articular disc (discus articularis), it forms the sternoclavicular joint (articulatio sternoclavicularis). This joint represents the only true bony connection between the upper limb and the axial skeleton.
Anatomy and Location
The manubrium sterni presents a central superior notch known as the jugular notch (incisura jugularis). On either side of this notch lie the two clavicular notches. The articular surface is covered by hyaline cartilage and divided into two separate joint compartments by a fibrocartilaginous articular disc. Strong ligaments – including the anterior and posterior sternoclavicular ligaments and the costoclavicular ligament – reinforce the joint and provide considerable stability despite the relatively small area of bony contact.
Function
The sternoclavicular joint, whose sternal component is the incisura clavicularis, allows shoulder girdle movement in all three planes of space:
- Elevation and depression (raising and lowering the shoulder)
- Protraction and retraction (forward and backward movement)
- Rotation of the clavicle along its long axis
Functionally, the joint behaves like a ball-and-socket joint, although anatomically it is classified as a saddle joint.
Clinical Relevance
Injuries
Injuries to the incisura clavicularis and sternoclavicular joint are uncommon but can occur following high-energy trauma or direct blows to the shoulder. Two main types of dislocation are distinguished:
- Anterior dislocation: The more common form; the medial clavicle displaces forward.
- Posterior dislocation: Less common but more dangerous – the medial end of the clavicle may compress the trachea, oesophagus, or major blood vessels.
Osteoarthritis
Degenerative changes of the sternoclavicular joint (sternoclavicular osteoarthritis) can cause localized tenderness, swelling, and restricted shoulder mobility. They occur more frequently in older patients and in individuals engaged in heavy manual labor or competitive sports.
Inflammatory Conditions
The sternoclavicular joint can become inflamed as part of rheumatic diseases (e.g., rheumatoid arthritis) or as a component of SAPHO syndrome. Septic arthritis (bacterial joint infection) at this location, while rare, has also been reported.
Diagnosis
The following imaging modalities are used to evaluate the incisura clavicularis and the adjacent joint:
- Conventional X-ray: Limited usefulness due to overlapping structures.
- Computed tomography (CT): Gold standard for bony pathology and dislocation assessment.
- Magnetic resonance imaging (MRI): Best suited for soft tissue, cartilage, and inflammatory changes.
- Ultrasound: Useful as a first-line assessment for joint effusion or swelling.
References
- Schünke M., Schulte E., Schumacher U. – Prometheus Atlas of Anatomy: General Anatomy and Musculoskeletal System. Thieme, Stuttgart, 5th edition, 2018.
- Rockwood C.A., Wirth M.A. – Disorders of the Sternoclavicular Joint. In: Rockwood and Matsen's The Shoulder. Elsevier, 5th edition, 2017.
- Williams G.R. et al. – Sternoclavicular Joint Injuries. Journal of the American Academy of Orthopaedic Surgeons, 2000; 8(4): 220–229.
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