OrthoFracs Logo

Sternoclavicular Joint Dislocations

Definition

  • Dislocation of the Sternoclavicular Joint

Incidence

  • Extremely uncommon injury

Aetiology

  • most commonly injured by MVA's, then sports
  • caused by lateral compression injury to arm

Anatomy

  • Stability of SC joint
    • is provided by joint capsule/costoclavicular & interclavicular ligaments
    • very little joint congruity
  • Medial epiphysis fuses with clavicle at 23-25 years; therefore, injuries in young adults often physeal

Classification

  • Direction of Dislocation
    • Anterior
      • more common by far
    • Posterior
      • more serious injury
      • least common
      • can present with venous engorgement, SOB, difficulty swallowing secondary to obstructiono of mediastinum
  • Mechanism of Injury
    • Traumatic
    • Atraumatic
  • Degree of Dislocation
    • Dislocation
    • Subluxation
  • Spontaneous Atraumatic Subluxation

Examination

  • Diagnosis can be difficult on physical examination

Investigations

Xrays

  • radiographs often are nondiagnostic
  • AP & 40° cephalic tilt view

CT scan

  • most reliable scan to show subluxation / dislocation
  • shows relation also to vascular structures & associated fractures

Treatment

All subluxations & sprains

  • treat nonoperative

Anterior Dislocation

  • usually managed nonoperative with activity modification & reassurance
  • may do closed reducation
    • traction & abduction
    • bump between shoulders
    • often unsuccessful
    • many remain unstable & usually not improved by open intervention
    • figure 8 splint for 6 weeks
  • persistent prominence is usually present but not of functional significance
    - atraumatic dislocation
    - no specific treatment is required, as the natural history is relatively good
    - traumatic dislocation: some patients may have pain & loss of function

Posterior Dislocation

  • may require treatment because of proximity of major neurovascular structures & airway
  • closed reduction
    • thorough vascular exam preop including CT scan to assess vascular injury & proximity
    • under GA in operating room
    • chest / vascular / cardiothoracic surgeon available to address any potential vascular or airway catastrophe associated with injuries to the mediastinum
    • Use abduction & traction & towel clip
    • Successful closed reduction usually stable
    • avoid Internal fixation because of likelihood of hardware migration & possible injury to the mediastinal structures
    • If closed reduction unsuccessful, open reduction is indicated

Physeal injuries

  • should generally be left alone to remodel
  • if symptomatic & posterior
    • then closed reduction can be done
  • Posterior dislocations require pre-op CT to assess vascular injury, & these require CR under GA with vascular notification

Spontaneous subluxator or dislocator

  • Do not operate

Recurrent or irreducible posterior dislocations in adults

  • may require medial clavicle excision & costoclavicular ligament reconstruction

Osteoarthritis from chronic dislocation

Complications

  • Potential Vascular Injury
  • Bump (cosmetic)
  • Degenerative Joint Disease
  • Mediastinal Impingement with Posterior Dislocation

Prognosis

  • Recurrent instability uncommon
  • Many apparent dislocations in adolescents may be growth plate injuries that will remodel without treatment
Webpage Last Modified: 4 March, 2010