Sternoclavicular dislocation: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
[[File:Sternoclavicular dislocation.png|thumb|Sternoclavicular dislocation]] | |||
===Sprain=== | ===Sprain=== | ||
*Pain and swelling are localized to the joint | *Pain and swelling are localized to the joint |
Revision as of 23:41, 21 July 2014
Background
- Very stable joint making a dislocation rare; majority of injuries are simple sprains
- Dislocations usually require severe force (MVC, sports injuries)
- Anterior dislocations are much more common than posterior
- Due to both force and anatomic location, damage to the brachial plexus, subclavian, trachea, and esophagus may occur[1]
Clinical Features
Sprain
- Pain and swelling are localized to the joint
Dislocation
- Severe pain that is exacerbated by arm motion and lying supine
- Shoulder appears shortened and rolled forward
- Anterior dislocation: prominent medial clavicle end is visible/palpable ant to sternum
- Posterior dislocation: Medial end is less visible and often not palpable
Diagnosis
- CT
- Study of choice (plain films may not be diagnostic)
- Consider IV contrast if concern for injury to mediastinal structures
- Serendipity view Xray
- Xray taken at a 40 degree cephalic tilt may be useful if CT unavailable.[1]
Management
- Symptoms of stridor or shortness of breath, or dysphagia indicate aerodigestive tract injury and require immediate reduction
Sprain
- Rice, sling, analgesics
Anterior Dislocation
- May discharged without attempted reduction (no impact on function)
- Clavicular splinting, ice, analgesics
- Ortho referral
Posterior Dislocation
- May be associated with life-threatening injuries:
- Pneumothorax, compression/laceration of surrounding great vessels, trachea, or esophagus
- Consult ortho for closed reduction (ideally performed in the OR or under Procedural Sedation)
- A towel clip could be used to grasp the medial clavicle, pulling anteriorly until reduction is complete
- May be observed afterwards due to severity of trauma and risk for vascular injury[2]
Source
- ↑ 1.0 1.1 Balcik BJ et al. Evaluation and treatment of sternoclavicular, clavicular, and acromioclavicular injuries. Prim Care Clin Office Pract 40 (2013): 911-923. PMID: 24209725
- ↑ Deren ME et al. Posterior sternoclavicular dislocations: a brief review and technique for closed management of a rare but serious injury. Orthopedic Reviews 2014; 6: 5245. PMID: 24744842