Joints and ligaments · Upper limb
Costoclavicular ligament !
The costoclavicular ligament ties the inner end of the collarbone to the first rib; it is the pivot of the collarbone when the shoulder moves.
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What it is
A short strong band from the first rib to the underside of the collarbone.
What it does
Acts as the pivot of the collarbone when the shoulder shrugs or moves forward.
Key facts
- Attaches
- 1st rib and its cartilage to the costal tuberosity of the clavicle
- Function
- Fulcrum of the clavicle
- Tight in
- Elevation of the clavicle (shrug)
Relations
- Above
- Costal tuberosity (rhomboid fossa) on the underside of the medial clavicle
- Below
- First rib and its costal cartilage
- Lateral
- Subclavian vein and the subclavius, the first structures of the costoclavicular space
- Medial
- SC joint, its capsule and the SC disc
How to find it
Not palpable: it lies deep under the medial end of the clavicle, behind subclavius and the clavicular head of pectoralis major, tying the clavicle to the first costal cartilage. Ultrasound just below the medial clavicle shows the space it borders.
Examination
- Costoclavicular (military brace) manoeuvre: shoulders pulled back and down; loss of the radial pulse or reproduction of arm symptoms suggests compression in the costoclavicular space (sensitive but not specific)
On imaging
Not seen on plain radiographs. Its attachment, the rhomboid fossa under the medial clavicle, can look like an irregular notch on an AP view and should not be mistaken for an erosion or a tumour. CT is the test of choice for sternoclavicular injuries and the medial clavicle; MRI shows the ligament itself and its tears.
Clinical notes
- Effort thrombosis of the subclavian vein (Paget–Schroetter syndrome) arises where the vein is squeezed between the clavicle, subclavius, first rib and this ligament
- First rib resection for venous thoracic outlet syndrome may include dividing the ligament to free the vein
- The costoclavicular approach to the brachial plexus block targets the three cords where they lie close together in this space
Anatomical variants
- The rhomboid fossa ranges from a smooth area or rough ridge to a deep pit; a deep pit is a normal variant
Test yourself
Think of the answer, then tap the question to see it.
Which structure is preserved when the medial end of the clavicle is resected?
The costoclavicular ligament, whose two twisted layers resist movement in every direction.
What passes through the costoclavicular space bounded medially by the costoclavicular ligament?
The subclavian vein, subclavian artery and brachial plexus on their way to the axilla.
What is the costoclavicular (military brace) manoeuvre?
Shoulders pulled back and down; loss of the radial pulse or arm symptoms suggest compression in the costoclavicular space.
Educational information, not medical advice. For any symptom, see a health professional.
Its names
- Official Latin (TA2)
- ligamentum costoclaviculare TA2 1756
- Official Spanish (DeCS)
- Ligamento costoclavicular
- English (TA2)
- Costoclavicular ligament
Related
Sources: Terminologia Anatomica (TA2); Anatomy, Shoulder and Upper Limb, Sternoclavicular Joint.
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Representative model, for educational purposes only.
