Posterior DIslocation of Sternoclavicular Joint
• An uncommon condition, but a true emergency (and we just managed one on 9/2/10)
• May be difficult to diagnose:
⇒ Physical exam – swelling over the area may prevent you from discerning the lack of the presence of the clavicular head.
⇒ Standard projection plain films may not illustrate the dislocation
• The key to diagnosis: thinking of it
– Mechanism: a compressive force applied to the shoulder, typically during contact sports
– Localization of discomfort with absence of fracture on plain film
– CT is often the preferred imaging modality; however, a cephalic tilt view (40 degrees) may also assist in the diagnosis (but will not help with determining vascular encroachment).
• Why the emergency? There isn’t much room under that clavicle… and the mediastinum doesn’t appreciate uninvited guests.
– Tracheal compression and respiratory distress. Potential erosion of the trachea also.
– Injury to superior vena cava, subclavian artery, carotid artery… all bad.
– Injury to brachial plexus
– Injury to esophagus
• Reduction often done by applying lateral traction to abducted arm under general anesthesia.
– Ideally would occur in the operating room, where vascular surgery can be on “standy-by” in case a vascular injury is found after attempted closed reduction.
– A towel clamp used to grasp the medial head of the clavicle can also be used to reduce the dislocation.
Yang J,Al-Etani H, Letts M. Diagnosis and treatment of posterior sternoclavicular joint dislocations in children. Am J Orthop 1996;25:565-9.
MacDonald, P., Lapointe, P. Acromioclavicular and Sternoclavicular Joint Injuries. Orthopedic Clinics of North America. 10/08;39