Pain referral from the sternoclavicular joint: a study in normal volunteers

Objective. The sternoclavicular joint (SCJ) is commonly affected by rheumat ological conditions. Case reports suggest that it may refer pain to distant areas, potentially leading to delays in diagnosis and inappropriately targ eted investigations. Therefore, we studied the patterns of pain referral fr om the SCJ of nine healthy volunteers. Methods. Hypertonic saline was injected into the SCJ of nine normal volunte ers and the location of any resulting pain was noted, as was the effect of resisted shoulder abduction and flexion. Composite pain maps were then cons tructed from individual pain diagrams. Results. An unpleasant, deep aching pain was produced locally in eight subj ects and referred to distant sites in all subjects. Tests of shoulder movem ent had varied and inconstant effects. Conclusions. We demonstrated that the SCJ is capable of referring pain to a reas distant from the joint. Knowledge of these referral patterns will enab le the SCJ to be considered in patients with pain in these areas.