Sternoclavicular dislocation

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Background

SC joint is freely movable synovial joint

Allows movement in nearly all planes

Very strong/stable due to connective tissue stabilizers - dislocation is UNCOMMON

Requires substantial force to dislocate

Anterior dislocation:posterior ratio 9:1


Mechanism

Anterior: anterior blow to lateral shoulder levers medial clavicle out

Poster: usually direct blow to medial clavicle


Presentation

Anterior

-usually not subtle

-can happen in elderly without significant trauma

-minimal potential for resultant morbidity


Posterior

Associated with sig force

25% incidence of mediastinal injury

-tracheal rupture

-PTX

-SVC lac

-Subclavian occlusion

-Vocal cord palsy


Imaging

Rountine Xray may appear nl

Serendipity View: 40˚ from vertical, direct cephalad

CT modality of choice

-can demonstrate co-injuries

MRI/MRA if necessary


Treatment

Anterior

-Reduction if you desire

-Bolster between shoulder blades, abduct arm to 90˚, press medial clavicle posteriorly and inferiorly

-May not reduce 2/2 interposed ligaments

-May not stay reduced 2/2 loss of ligament support

-Sling

-Ortho f/u


Posterior

-Difficult to reduce

-Prep, place towel clips, pull anteriorly while (assistant) placing traction and abduction to ipsilateral arm

-Sling

-Ortho f/u

-Admit if other mediastinal injury


Source

Perron (ACEP '09)