My Chest Hurts. Shalini Chandra MD January 26, 2005. Case History.
Shalini Chandra MD
January 26, 2005
When asked about pain, he said it hurt at first but then he didn’t think about it. When asked about sensory loss, he said after the tournament, he noticed a little tingling in his fingers, but as long as he keeps his elbow bent it is okay. He had also noted it to be slightly blue, but this too has since resolved.
Our patient was taken to an outside hospital first, where an x-ray and a ct scan were done. The films were read as a posterior sternoclavicular joint dislocation. The physicians, promptly put the hero’s right arm in a figure 8 sling and sent him to the one…the only…Penguin Pod at CHM!
Here, at CHM, we promptly collected the films brought to us by our hero himself. The SC joint did not look quite right.
We examined our patient. We did not remove the sling, however his arm was pink, and his sensation perfect…even at the tips of his little fingers.
We were able to illicit pain on palpation of the upper right sternal border, and mild neck tenderness upon turning neck to the left.
We promptly notified the orthopedic surgeon on call of the situation who requested us to have the films read by our radiologist, and if indeed the dislocation was greater than one centimeter, he would reduce it.
Although he initially denied pain, since he had received motrin at the outside hospital, he did eventually ask for some more motrin. We granted his wish.
Then we waited for the surgeon and the radiologist to give their verdict…
The SC joint was indeed separated and moderately sprained but not dislocated completely…ie it was less than 1cm displaced, thus no further intervention was needed and our superhero went home with the sling and was to follow-up with orthopedic surgery in 7-10 days to reassess and begin increasing range of motion.
He will likely return to sports upon regaining full and pain-free range of motion.
An unusual dislocation at the sternoclavicular joint that is usually the result of compressive forces on the shoulder girdle. The forces of posterior compression transmit through the fulcrum of the costoclavicular ligament and result in posterior dislocation. Alternatively, a direct blow to the anteromedial clavicle can result in posterior dislocation.