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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 Jason Blackham, MD Clinical Assistant Professor Division of General InternalMedicine 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 • Dysphagia • Unremarkable PMH
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 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 • Shoulder dislocation • Proximal clavicular fracture • Sternoclavicular joint dislocation • Traumatic pneumothorax
AF C C BV T BV E BA R
Diagnosis • Posterior sternoclavicular joint dislocation with avulsion fracture
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
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 • 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 • SC joint arthritis • Cosmetic appearance • Persistent prominence • Chronic pain • Recurrent instability
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 • Anterior Dislocation • Controversial • Majority unstable following reduction • Sling immobilization for 6 weeks • If continued symptoms, surgery
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 • 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 • Claviculectomy • Resection of medial clavicle • Reconstruction of capsule or ligaments • Not pinning • Migration of transfixion pins
Operative Treatment • Capsule repair with tendon graft • Burrow’s procedure • Sublcavius tendon tenodesis • Fascia lata graft • Sternocleidomastoid muscle • Medial clavicle osteotomy
Outcome • Completed FB season without pain or instability • Pitched for high school baseball team
Summary • Posterior SC dislocations are rare • Potentially severe complications • Closed reduction is preferred • RTP after healing and ROM regained • generally 6-14 weeks