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

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