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Sternoclavicular joint dislocation. Jason Blackham, MD Clinical Assistant Professor Division of General Internal Medicine University of Iowa Sports Medicine Center. History. 17 yo high school quarterback was sacked during a game Complained of Right antero-inferior neck pain Dyspnea

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sternoclavicular joint dislocation

Sternoclavicular joint dislocation

Jason Blackham, MD

Clinical Assistant Professor

Division of General InternalMedicine

University of Iowa Sports Medicine Center

history
History
  • 17 yo high school quarterback was sacked during a game
  • Complained of
    • Right antero-inferior neck pain
    • Dyspnea
    • Dysphagia
  • Unremarkable PMH
physical exam
Physical Exam
  • RR 20, HR 84
  • Normal mentation and no resp distress
  • Neurological exam normal
  • Pain with palpation of right clavicle
    • Loss of fullness of proximal clavicle
    • No skin tenting
physical exam5
Physical Exam
  • Walked off the field
    • Postured with head tilted (R), arm at side in IR with elbow at 90 degrees flexion
  • Off field exam
    • Trachea midline, no stridor
    • Breath sounds normal, symmetric, resonant
    • No cardiac murmer or rub and symmetric pulses
  • Transported to ED
differential diagnosis
Differential Diagnosis
  • Shoulder dislocation
  • Proximal clavicular fracture
  • Sternoclavicular joint dislocation
  • Traumatic pneumothorax
slide9

AF

C

C

BV

T

BV

E

BA

R

diagnosis
Diagnosis
  • Posterior sternoclavicular joint dislocation with avulsion fracture
treatment
Treatment
  • Reduction under general anesthesia
  • 4 weeks immobilized in sling
  • 2 weeks of protected ROM, strengthening
  • Cornerback for 3 weeks
  • Returned to quarterback at 9 weeks
epidemiology
40% MVC

21% Sports

39% Other Trauma

~3% of all shoulder girdle injuries

> 90% anterior dislocations

Epidemiology

Clin Sports Med 2003;22:387-405

Phys Sports Med 1999;27(2):105-13

mechanisms of posterior
Mechanisms of Posterior
  • Fall on shoulder with arm flexed and adducted
    • Lateral force to shoulder when shoulder rolled forward
  • Posterolateral force to shoulder while opposite shoulder on ground
  • Force to anteromedial clavicle

Clin Sports Med 2003;22:387-405

Military Med 2004;169(2):134-6

Rockwood and Green’s Fractures in Adults. 1997

complications of anterior
Complications of Anterior
  • SC joint arthritis
  • Cosmetic appearance
    • Persistent prominence
  • Chronic pain
  • Recurrent instability
complications of posterior
Complications of Posterior
  • Pneumothorax
  • Compression or laceration
    • Trachea
    • Esophagus
    • Artery / Vein
  • SVC laceration
  • Brachial plexus injury
  • Thoracic outlet obstruction

J Trauma 1998;44(2):381-3

Clin Sports Med 2003;22:371-85

treatment of anterior
Treatment of Anterior
  • Anterior Dislocation
    • Controversial
    • Majority unstable following reduction
    • Sling immobilization for 6 weeks
    • If continued symptoms, surgery
treatment of posterior
Treatment of Posterior
  • Recommendation is for closed reduction
    • <48 hrs to <7 days of injury
  • Sling or figure-of-eight
  • Single review article & case studies
    • good results
  • If unstable or complications, then open

Clin Sports Med 2003;22:359-70

Clin Sports Med 2003;22:387-405 Can J Surgery 1986;29(2):104-6

J Trauma 1967;7(3):416-23

return to play
Return to Play
  • Sling or figure-eight harness for 4-6 weeks
  • Return when pain free motion
    • may require additional 4-8 weeks

Military Med 2004;169(2):134-6

Phys Sports Med 1999;27(2):105-13

operative treatment
Operative Treatment
  • Claviculectomy
  • Resection of medial clavicle
  • Reconstruction of capsule or ligaments
  • Not pinning
    • Migration of transfixion pins
operative treatment30
Operative Treatment
  • Capsule repair with tendon graft
  • Burrow’s procedure
    • Sublcavius tendon tenodesis
  • Fascia lata graft
  • Sternocleidomastoid muscle
  • Medial clavicle osteotomy
outcome
Outcome
  • Completed FB season without pain or instability
  • Pitched for high school baseball team
summary
Summary
  • Posterior SC dislocations are rare
  • Potentially severe complications
  • Closed reduction is preferred
  • RTP after healing and ROM regained
    • generally 6-14 weeks