Sternoclavicular dislocation

Revision as of 23:30, 9 February 2012 by Jswartz (talk | contribs)

Background

  • Very stable joint; majority of injuries are simple sprains
  • Dislocations usually require severe force (MVC, sports injuries)
    • Anterior dislocations are much more common than posterior

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

Treatment

Sprain

  • Rice, sling, analgesics

Anterior Dislocation

  • May d/c without attempted reduction (no impact on function)
  • Clavicular splinting, ice, analgesics
  • Ortho referral

Posterior Dislocation

  • May be assoc w/ life-threatening injuries:
    • PTX, compression/laceration of surrounding great vessels, trachea, or esophagus
  • Consult ortho for closed reduction (ideally performed in the OR)

Source

  • Tintinalli