Pain and swelling of the medial end of the clavicle may be associated with radiographic sclerosis. The commonest causes are osteoarthritis, infection and condensing osteitis of the clavicle. Distinguishing between these clinically and radiologically can be difficult but computed tomography (CT) and magnetic resonance imaging (MRI) are often useful for their differentiation. In this review, the typical imaging features of these conditions are presented with an emphasis on the CT and MRI appearances. These are correlated with clinical features, which together should enable a confident diagnosis to be made.