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ULY CLINIC

22 Septemba 2025, 00:13:49

Clavicular sign

Clavicular sign refers to swelling, puffiness, or edema at the medial third of the clavicle, most often observed in congenital syphilis. It reflects underlying periostitis or osteochondritis of the clavicle due to treponemal infection.

Pathophysiology

Treponema pallidum infection in utero leads to inflammation of the periosteum and adjacent bone tissue.
This inflammatory response produces localized edema, tenderness, and swelling at the medial clavicle.
Chronic inflammation may result in thickening or deformity of the clavicular region.
The sign is most evident during the early postnatal period, reflecting active congenital infection.

Examination Technique

Patient Observation

Inspect the medial third of both clavicles for asymmetry, swelling, or puffiness.
Palpate gently for tenderness, warmth, or firmness.

Assessment

Compare the affected clavicle with the contralateral side.
Document the extent, consistency, and symmetry of the swelling.
Evaluate for associated signs of congenital syphilis, including snuffles, rash, hepatosplenomegaly, and skeletal abnormalities.

Clinical utility

Indicator of congenital syphilis: Often observed in infants with treponemal infection.
Supports early diagnosis: Helps guide further serologic testing and intervention.
Assessment of disease severity: Extent of clavicular involvement may reflect systemic infection.

Differential Diagnosis

Cause / Condition	Key Features	Notes
Congenital syphilis	Medial clavicular swelling, snuffles, rash, hepatosplenomegaly	Most common cause of clavicular sign
Neonatal trauma	Localized clavicle swelling post-delivery	Usually unilateral; history of birth trauma helpful
Osteomyelitis	Fever, localized tenderness, erythema	Infection may mimic clavicular sign; confirm with imaging and labs
Congenital skeletal dysplasias	Bilateral clavicular deformities	Typically associated with other skeletal abnormalities

Pediatric considerations

Clavicular sign is primarily observed in neonates and young infants.
Early recognition facilitates prompt initiation of antibiotic therapy to prevent complications.
Monitoring for other skeletal or systemic manifestations of congenital syphilis is essential.

Geriatric considerations

Rarely relevant in older children or adults, as the sign is associated with congenital conditions.

Limitations

Swelling may be subtle and easily overlooked.
Must differentiate from trauma, infection, or congenital skeletal anomalies.
Not pathognomonic alone; serologic confirmation is required for diagnosis.

Patient counseling

Explain that swelling at the clavicle may indicate congenital infection, which is treatable.
Discuss the importance of further testing and antibiotic therapy.
Emphasize follow-up to monitor growth, development, and bone health.

Conclusion

Clavicular sign is a classic clinical marker of congenital syphilis, reflecting periosteal inflammation of the medial clavicle. Proper recognition, examination, and correlation with other systemic signs are essential for early diagnosis and effective treatment.

References

Partridge SJ. The clinical manifestations of congenital syphilis. Pediatr Clin North Am. 2000;47(6):1343–1363.
Radolf JD, et al. Treponema pallidum (Syphilis) Pathogenesis. Microbiol Spectr. 2017;5(1):1–25.
Kliegman RM, et al. Nelson Textbook of Pediatrics. 23rd ed. Philadelphia: Elsevier; 2021.
American Academy of Pediatrics. Red Book: 2021 Report of the Committee on Infectious Diseases. 32nd ed. Elk Grove Village, IL: AAP; 2021.
Woods CR. Congenital and neonatal syphilis. Semin Fetal Neonatal Med. 2007;12(3):162–173.