INTRODUCTION Sternoclavicular joint tuberculosis is rare and has been presented in literature with few sporadic case reports or small case series. Rarity of the condition, nonspecific symptoms, difficulty to visualise the area on X-rays, and minimal clinical signs make diagnosis of sternoclavicular tuberculosis extremely difficult. Delay in diagnosis is therefore the common feature of all presented reports in literature. We here present our experience of treating 19 cases of sternoclavicular tuberculosis at our centre. MATERIALS AND METHOD This is an observational study from 2010 to 2017 in a tertiary care referral hospital. All patients with clinical tenderness of sternoclavicular joint and shoulder joint pain of over three week duration were subjected to MRI. Patients who showed radiological lesions (radiography/MRI) were subjected to core biopsy under image guidance. A total of 26 patients had biopsy confirmed sternoclavicular tuberculosis (TB) during this period. RESULTS All patients had improvement in shoulder function after treatment completion. Mean CSS pre-treatment was 29 which improved to mean of 8 after 18 months of ATT. Eight patients had excellent results, seven good, three fair, and one patient poor result. High initial ESR, late commencement of ATT from initial symptoms, and surgery of the involved joint were considered poor prognostic factors. DISCUSSION Sternoclavicular tuberculosis is a rare disease with controversial etiology. Both haematogenous spread through suprascapular artery and contiguous spread through latent disease in apical lungs has been postulated. Delay in diagnosis is common to most reports in literature. Early MRI is useful in diagnosis of the lesion. The treatment for sternoclavicular joint in literature is controversial with proponents of both surgery and conservative management. CONCLUSION Primary sternoclavicular tuberculosis is rare condition and requires a high index of suspicion for an early diagnosis. A focused sternoclavicular MRI and early biopsy may help in timely diagnosis. Early commencement of ATT has overall good clinical and functional results.

中文翻译：

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锁骨胸骨结核：难治性肩痛的非典型模仿者。

引言锁骨关节结核很罕见，并且在文献中很少出现零星病例报道或小病例系列报道。疾病的稀有性，非特异性症状，难以在X射线上显示该区域以及极少的临床体征使得对胸锁肺结核的诊断极为困难。因此，诊断延迟是文献中所有已提交报告的共同特征。我们在这里介绍我们在我们中心治疗19例胸锁骨结核的经验。材料与方法这是2010年至2017年在三级转诊医院进行的一项观察性研究。对所有持续时间超过三周的肩锁关节痛和肩关节痛临床压痛的患者进行MRI检查。表现出放射性病变（影像学/ MRI）的患者在图像指导下接受核心活检。在此期间，共有26例活检证实为胸锁肺结核（TB）。结果所有患者治疗完成后肩部功能均有改善。平均CSS预处理为29，ATT接受18个月后平均改善为8。8例患者的结果优异，7例好，3例一般，1例结果较差。较高的初始ESR，因初始症状而导致的ATT迟发以及受累关节的手术被认为是不良的预后因素。讨论锁骨结核是一种罕见的病因，具有争议性。既有通过肩sup上动脉的血源性传播，也有通过顶端疾病中的潜伏性疾病的连续传播。诊断延迟是大多数文献报道所共有的。早期MRI对病变的诊断很有用。文献中对锁骨干关节的治疗引起争议的是手术和保守治疗的支持者。结论原发性锁骨肺结核是罕见病，需要高度怀疑才能早期诊断。聚焦的锁骨MRI和早期活检可能有助于及时诊断。ATT的早期启动总体上具有良好的临床和功能效果。结论原发性锁骨肺结核是罕见病，需要高度怀疑才能早期诊断。聚焦的锁骨MRI和早期活检可能有助于及时诊断。ATT的早期启动总体上具有良好的临床和功能效果。结论原发性锁骨肺结核是罕见病，需要高度怀疑才能早期诊断。聚焦的锁骨MRI和早期活检可能有助于及时诊断。ATT的早期启动总体上具有良好的临床和功能效果。