clavicle knot

About 2 months ago I noticed a knot on my clavicle to the right of the "angle of Louis" . Recently I notice it has grown and spread in size. Should this be something to be concerned about?

[Michael L Gross, MD]

Atraumatic swelling of the sternoclavicular joint is usually degenerative arthitis or osteoarthritis. Since you did not mention any trauma this seems the likely cause. Osteoarthritis of the SC joint usually responds to treatments such as rest, ice, physical or occupational therapy, and anti-inflammatory medications. If the symptoms of osteoarthritis do not respond to basic treatment over six to 12 months, surgery may be considered, but it is rarely, if ever indicated.
  
If the swelling is not at the SC joint, but rather at the joints between the sternum and ribs, there is another consideration, Tietze Syndrome. There is swelling as well as tenderness of the rib-cartilage junctions in Tietze syndrome. Although some doctors use the terms costochondritis and Tietze syndrome interchangeably, they are actually two different entities. Tietze syndrome has a sudden onset without any preceding respiratory illness or any history of minor trauma. Costochondritis should be distinguished from Tietze syndrome, a condition involving the same area of the front of the chest. Costochondritis is not associated with swelling, as opposed to Tietze syndrome where swelling is characteristic. Tietze syndrome is an inflammation of the costochondral cartilages of the upper front of the chest. Again, the mainstay of treatment is usually ice and anti-inflammatory medications.

In Tietze syndrome, there is frequently radiation of pain to arms and shoulders as well as pain and tenderness associated with swelling at the spot that hurts. THe radiating pain is similar to cardiac pain, and therefore cardiac problems should always be ruled out.