Tuberculosis of the sternoclavicular joint: a systematic review of the literature

Sternoclavicular joint tuberculosis representing less than 1% of osteoarticular tuberculous cases. Due to its rarity, this tuberculous localization is often unrecognized and underdiagnosed, leading to delayed management and potentially severe complications. This study aimed to systematically review of sternoclavicular tuberculosis cases reported worldwide. This systematic review was conducted according PRISMA guidelines. Electronic searches were conducted in databases including Medline via PubMed, Embase, Scopus, CINAHL, Web of Science, Google Scholar, DOAJ, and regional databases up to March 2025 in English language. Studies reporting confirmed sternoclavicular tuberculosis cases with clinical, diagnostic, therapeutic, or evolutionary data were included. Two reviewers independently screened articles, completed the data extraction and assessment of risk of bias. Due to significant heterogeneity and paucity of data, we were unable to carry out a meta-analysis. The Joanna Briggs Institute (JBI) critical appraisal tools were used for quality assessment. The protocol for this review was registered on the International Prospective Register of Systematic Reviews. We identified 495 records and a total of 48 studies documenting 117 patients were included, published between 1955 and 2024, with 77.08% (n = 37) published after 2010. Case reports dominated with 70.83% (n = 34), followed by case series 22.91% (n = 11) and observational studies 6.25% (n = 3). The mean patient age was 42.4 years (SD 17.16) with male predominance 63.8% (n = 74). India accounted for 77.8% (n = 91) of cases. Only 34.2% (n = 40) of patients had identifiable risk factors, with HIV and diabetes being most common at 5.1% (n = 6) each. Clinical presentation included localized pain 79.5% (n = 93), swelling 88.9% (n = 104), and mean symptom duration of 5.17 months before diagnosis. Right-sided involvement predominated with 60.7% (n = 65). Associated extrapulmonary tuberculosis was present in 22.2% (n = 26) of cases. Treatment duration averaged 12.59 months, with standard 7–12-month treatment in 41.5% (n = 34) and prolonged 13–18-month treatment in 40.2% (n = 33). Surgical intervention was required in 20.5% (n = 24) of cases. Clinical evolution was favorable in 55.5% (n = 65) of documented cases. Sternoclavicular tuberculosis remains a rare but likely underdiagnosed condition characterized by atypical presentation leading to diagnostic delays. This review highlights the need for increased clinical suspicion, standardized diagnostic approaches, and prospective multicenter studies to establish evidence-based recommendations for optimal treatment duration and surgical indications.