Sternoclavicular dislocation

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

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.

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