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Sternoclavicular dislocation is a rare injury; it is usually the result of
a fall on the shoulder. Anterior dislocations are more common (by a 9:1 ratio)
than posterior dislocations of the sternoclavicular joint (SCJ). In anterior
SJC dislocation then there is usually a visible and palpable prominence that
results from the superomedial displacement of the clavicle.
Pathophysiology:
- anterior dislocations of the SCJ may occur from an indirect mechanism such
as a blow to the anterior shoulder. The force of blow causes rotation of the
shoulder backwards and transmits the stress to the SCJ
- posterior SCJ dislocation may occur secondary to direct trauma to the anteromedial
aspect of the clavicle that drives it backward
Management:
- specialist review in Accident and Emergency Department
- SCJ sprains require only symptomatic treatment, for example:
- immobilization with a sling
- ice for 24-48 hours
- analgesia
- anti-inflammatory medications if not contraindicated
- posterior SCJ dislocations require an expeditious diagnosis and treatment,
due to the proximity of the displaced medial clavicle to the great vessels
- an early closed reduction will usually be stable. Operative stabilization
must, however, be considered if the closed reduction is unsuccessful or
there is persistent SC instability. Note that if a patient has a posterior
SCJ dislocation then there are often serious associated injuries that
require treatment that take treatment precedence over the dislocation,
for example:
- tracheal rupture or erosion
- pneumothorax
- laceration of the superior vena cava
- occlusion of the subclavian artery and/or vein
- acute anterior dislocations, in general, are treated nonoperatively.The
patients should be informed that there is a high risk of persistent instability
with nonoperative or operative care, but that the persistent instability will
be well tolerated and have little functional impact in the vast majority.
Therefore, operative intervention for anterior SC joint instability is mainly
cosmetic in nature (1)
Reference:
- Bicos
J, Nicholson GP. Treatment and results of sternoclavicular joint injuries.
Clin Sports Med. 2003 Apr;22(2):359-70
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