DEAR DR. GOTT: I am a 76-year-old female in generally good health. I see my doctor regularly and take only one prescription drug, levothyroxin 75 mcg.
I have developed what my doctor diagnosed as a mass on my sternal clavicular joint, with his first reaction being Hodgkin’s lymphoma. An immediate CT scan proved inconclusive so he ordered a sonogram and biopsy. These tests, too, showed nothing serious. I was to apply a heat pad, making the lump shrink. It did not work and while the lump is hard (bone?), it doesn’t hurt. However, it is uncomfortable when extending my arm or when lifting something heavy.
At the same time and on the same side, the pulse in my neck is clearly visible. As a matter of fact, when exercising by walking briskly or dancing, it literally bulges out. I was told that it was a loose, squiggly artery. I was probably born with it and nothing needs to be done.
I would appreciate if you could give me guidance such as whether I should seek a second opinion (which I am doing now, I guess). Thank you.
DEAR READER: The sternoclavicular joint is the area on the body where the collarbone meets the breastbone. There are two joints, one on the left and one on the right. A capsule envelops the joints and ligaments to provide strength; therefore, dislocation is rare. Inside each joint is a flat disc comprised of fibrous cartilage. This disc acts as a shock absorber. The joint is able to move in all directions – forward, backward, up and down; however, actual range of motion is relatively limited.
While uncommon, injury to the joint can occur from such things as being tackled on a football field, hitting an automobile steering wheel, or being diagnosed with osteoarthritis. Injuries can tear, forcing the bones of the joint out of position, while osteoarthritis can cause pain and stiffness. Until the age of about 25, a portion of the clavicle is cartilage, not bone. Symptoms of injury can include a grating sensation, popping or clicking sounds on movement. While extremely uncommon, posterior dislocations can be extremely serious because of the potential to damage organs and blood vessels within the chest. This can result in difficulties breathing or swallowing. Anterior dislocations are far less serious and the clavicle pushes forward in front of the sternum, allowing the end of the clavicle to be felt on palpation. Often, a hard lump on one side of the center of the of the upper chest will also be present. I’d be surprised if you have a dislocation because of the potential for extreme pain; however, the possibility remains. If dislocation is a reality, whether posterior or anterior, closed reduction is performed unless the injury is so severe that surgery is required. Immobilization and ultimate muscle strengthening will follow.
To touch on Hodgkin’s lymphoma, symptoms include fatigue, fever, chills, loss of appetite, swollen glands in the neck, armpits and groin, skin flushing, and more. Diagnosis is commonly made with the assistance of lymph node biopsy, CT, CBC, PET scan, and more in order to determine if this cancerous condition has spread to other sites from the lymph nodes. This diagnosis probably would not have been my first guess, nor my second.
I agree with your decision to seek a second opinion. It can certainly do no harm and might give you the peace of mind so important in dealing with a now unknown situation.
Your pulsating neck could be a number of things, from a congenital (from birth) defect such as your physician suggested to a possible sign of carotid blockage. Your physician has determined nothing need be done, so you have the option of either trusting his judgment or making an appointment with a specialist for a second opinion. Keep me posted.
