AUTHOR AND EDITOR INFORMATION

Section 1 of 11  

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• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
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INTRODUCTION

Section 2 of 11  

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• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
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Background

A freely moveable synovial joint links the upper extremity to the torso, with the sternoclavicular joint (SCJ) participating in all movements of the upper extremity. The SCJ is a saddle-type joint that provides free movement of the clavicle in nearly all planes. The ability to thrust the arm and shoulder forward requires sound function of the SCJ. Because only about 50% of the medial end of the clavicle articulates with the manubrium, the SCJ has little inherent stability. Most of the SCJ's strength and stability originates from the joint capsule and supporting ligaments. The capsule surrounding the joint is weakest inferiorly, while it is reinforced on the superior, anterior, and posterior aspects by the various ligaments. These include the interclavicular, anterior and posterior sternoclavicular, and costoclavicular ligaments.

Pathophysiology

Only through the application of significant force do the ligaments supporting the SCJ become completely disrupted, enabling dislocation of the joint. Whether the SCJ subluxes or dislocates depends on the extent of the damage to the supporting ligaments and capsule. Sternoclavicular joint injuries (SJIs) are graded into 3 types.

• A first-degree injury, or simple sprain, constitutes an incomplete tear or stretching of the sternoclavicular and costoclavicular ligaments. Discomfort is mild, and no instability is present. This is the most common type of SJI.
• With a second-degree injury, the clavicle undergoes an anterior or posterior subluxation from its manubrial attachment, signifying a complete breach of the sternoclavicular ligament but at most, only a partial tear of the costoclavicular ligament.
• With a third-degree injury, complete rupture of the sternoclavicular and costoclavicular ligaments permits the clavicle to completely dislocate from the manubrium.

A significant direct or indirect force to the shoulder region can cause a traumatic dislocation of the SCJ. Anterior dislocations of the SCJ are much more common (by a 9:1 ratio), usually resulting from an indirect mechanism such as a blow to the anterior shoulder that rotates the shoulder backward and transmits the stress to the joint. Traumatic contact driving the shoulder forward can cause posterior dislocations of the SCJ, as can direct impact to the superior sternal or medial clavicular surfaces.

Frequency

United States

The ligaments and capsule of the SCJ contribute enough stability to make this one of the least dislocated joints in the body. Sternoclavicular dislocations are uncommon, accounting for only 3% of a series of 1603 shoulder girdle injuries. Posterior dislocations are much less common than anterior dislocations. Posterior dislocations are considerably less common than anterior dislocations. Only 1 of these 1603 injuries was a posterior dislocation.

Mortality/Morbidity

Mortality and significant morbidity occur infrequently with anterior dislocations of the SCJ. Problems are usually related to issues of physical appearance as well as pain and functional limitations for persons with an active lifestyle.

However, a posterior SCJ dislocation has an estimated 25% complication rate. Complications from posterior displacement of the clavicle can include pneumothorax, laceration of the superior vena cava, occlusion of the subclavian artery or vein, and disruption of the trachea. All of these complications can cause significant disability and even death.

Sex

Overall incidence is higher in males than in females because of the activities (eg, motor vehicle crash, contact sports) associated with the injury. However, recurrent atraumatic anterior subluxation of the SCJ (usually associated with overall joint laxity) though rare occurs more frequently in young girls.

Age

Incidence is increased in young adult males, since this population is engaged more often in activities associated with SJI, such as motor vehicle crashes and contact sports.

CLINICAL

Section 3 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

History

• Determine the onset of pain and the mechanism of injury.
• • SCJ dislocations may follow direct trauma to the anteromedial aspect of the clavicle that drives it backward and causes a posterior dislocation.
  • More commonly, dislocations arise from an indirect force applied to the anterolateral or posterolateral shoulder that compresses the clavicle down toward the sternum. The direction the shoulder is driven determines the type of dislocation. When overwhelming compression propels the shoulder forward, the force directed toward the clavicle produces a posterior dislocation of the sternoclavicular joint. If the shoulder is pressed and rotated backward, the force directed down the clavicle produces an anterior dislocation of the sternoclavicular joint.
• Atraumatic SCJ dislocations occur rarely.
• Patients commonly complain of chest and shoulder pain exacerbated by arm movement or by assuming a supine position.
• Pain tends to be more severe with posterior dislocations.
• Additional symptoms may be caused by associated injuries or by compression of adjacent structures by a posterior SCJ dislocation and may include the following:
• • Dyspnea
  • Dysphagia
  • Paresthesias

Physical

• Patients present with their head tilted toward the affected side and hold the affected arm across the trunk with the uninjured arm.
• Check vital signs, especially respirations.
• • Tachypnea, stridor, and other signs of respiratory distress (posterior dislocations) may be present.
  • Verify adequacy of circulation. Venous congestion of the head, neck, and/or affected arm may result from posterior dislocations.
• The affected shoulder usually appears shortened and thrust forward.
• • Generally, edema and tenderness are present over the SCJ.
  • Pain manifests with any range of motion testing that affects the SCJ and becomes more severe when a lateral compressive force is applied to the shoulders.
• When viewed from the level of the patient's knees, anterior SCJ dislocations demonstrate a conspicuous asymmetry, with the medial aspect of the affected clavicle appearing prominent. Palpation reveals a medial protrusion.
• Physical findings at the SCJ may be more subtle with posterior SCJ dislocations, with swelling and a defect evident on inspection and palpation.
• • The corner of the sternum on the affected side may be palpated more readily than on the noninjured side.
  • Palpation often reveals exquisite tenderness medially.
  • Soft tissue swelling may obscure any defect and create the false impression of an anterior dislocation.

Causes

• Motor vehicle crashes are the most common mechanism producing sternoclavicular dislocation.
• Athletic injury
• • In a "pile-on" in football, the shoulder off the ground may be rolled backward, causing an anterior dislocation, or rolled forward, causing a posterior dislocation.
  • During a sporting event, an athlete lying on his or her back may be jumped on with the knee of the jumper landing directly on the medial end of the clavicle. A kick delivered to the front of the medial clavicle can also produce dislocation.
• Falls (eg, a person falling on an outstretched abducted arm, driving the shoulder medially)
• Dislocations of the sternoclavicular joint also may result from congenital, degenerative, and inflammatory processes.
• Ligamentous laxity, more common in young girls, is associated with recurrent atraumatic anterior dislocations of the sternoclavicular joint. This tends to be a self-limited condition.

DIFFERENTIALS

Section 4 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

WORKUP

Section 5 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

Imaging Studies

• Routine radiographs of the sternoclavicular joint are often difficult to interpret and may falsely appear normal.
• • A specialized view, known as the serendipity view and described by Rockwood (1975), may reveal the medial clavicle position. For this technique, the beam is tilted to 40° from vertical and directed cephalad through the manubrium of the patient while in a supine position. Normal clavicles should appear in the same horizontal plane, while anterior and posterior dislocations appear above and below the plane, respectively.
  • In the Hobbs view, the patient sits at the radiography table and leans forward so that the anterior chest is in contact with the film cassette and the flexed elbows straddle the cassette and support the patient. The x-ray beam is aimed directly down through the cervical spine, projecting the sternoclavicular joints onto the film cassette.
• Unquestionably, CT scan is a better technique to study problems of the sternoclavicular joint.
• • Request inclusion of both sternoclavicular joints and the medial half of both clavicles on the CT scan so the injured side can be compared with the noninjured side.
  • In addition to revealing the position of the medial clavicle, CT scan provides important information about the vital tissues of the superior mediastinum, which may be concomitantly injured.
• Other imaging studies, such as angiography or esophagoscopy, may be indicated when mediastinal injuries from a posterior dislocation are suspected.
• MRI provides the same information as a CT scan while better documenting the soft tissue anatomy and associated mediastinal structures.

TREATMENT

Section 6 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

Prehospital Care

• Depending upon the mechanism of injury (eg, motor vehicle crash) and the close proximity of the sternum and clavicle to the vital structures of the neck and chest, patients with SCJ injuries may incur severe and life-threatening additional injuries.
• Foremost, address the ABCs during prehospital care, with rapid transport to an appropriate trauma care facility.
• For patients with seemingly isolated SJI, immobilization of the affected upper extremity with a sling stabilizes the joint and minimizes pain.

Emergency Department Care

Patients with posterior SCJ dislocations frequently (up to 25% of the time) sustain associated serious injuries that take treatment precedence over the dislocation.

• Sprains of the SCJ require only symptomatic treatment (ie, immobilization with a sling, ice for 24-48 h, analgesics, and anti-inflammatory medications).
• Acute anterior dislocations usually can be treated nonoperatively, but interposition of the joint capsule or the ligaments can make the joint irreducible. Additionally, maintaining reduction of anterior dislocations often is difficult. Carry out closed reduction of an anterior dislocation as follows:
• • Place the patient in a supine position on the stretcher.
  • Place a 3- to 4-inch thick bolster (rolled sheet or sandbag) between the scapula and spine (to help separate the clavicle from the manubrium).
  • Have an assistant abduct (to 90°) and extend (10-15°) the shoulder on the affected side and apply traction.
  • If reduction does not occur, apply pressure to the medial clavicle in a posterior and inferior direction.
  • Treatment options for recurrent/unreduced anterior SCJ dislocations may include open reduction and internal fixation, or acceptance of some degree of permanent instability, depending on the patient's characteristics and functionality.
  • Closed reduction with conscious sedation or general anesthesia, while the preferred initial treatment, may not be possible. Because of potential associated vascular injury, the operating room may be the more appropriate setting for reduction.
• Acute posterior dislocations are a more serious injury because of their association with vascular injuries to the intrathoracic and superior mediastinal structures and are typically reduced in an operating room with the patient under general anesthesia. The treatment of associated injuries and/or complications may take priority over the SCJ dislocation. Emergent closed reduction of a posterior dislocation is as follows:
  • Place the patient in a supine position on the stretcher.
  • Place a 3- to 4-inch thick bolster (rolled sheet or sandbag) between the scapula and spine (to help separate the clavicle from the manubrium).
  • Abduct (90°) and extend (10-15°) the shoulder on the affected side and apply traction to the arm as an assistant applies countertraction to the trunk.
  • If traction fails to reduce the dislocation, pull the medial clavicle forward while an assistant maintains traction and an abduction force on the affected limb.
  • In situations in which the clavicle cannot adequately be grasped by the fingers, use a towel clip to grip the clavicle (after sterile preparation of the skin) and pull forward.
  • Treatment options for unreduced posterior SCJ dislocations may include open reduction and internal fixation, or acceptance of some degree of permanent instability, depending on the patient's characteristics and functionality.
  • An alternative technique to prepare for reduction of a posterior SCJ dislocation (proposed by Buckerfield and Castle) suggests caudal traction accompanying adduction of the affected arm, along with downward pressure on both shoulders.
  • Closed reduction attempts for posterior SCJ dislocations may fail or may be associated with complications such as injury to the adjacent mediastinal structures.
• • Closed reduction may be unsuccessful or not attempted, depending on the age and activity level of the patient. In such patients, an immobilizing sling, analgesics, and anti-inflammatory agents may be used for symptomatic relief.

Consultations

• Consult an orthopedic surgeon for reduction and possible operative stabilization of posterior dislocations.
• Suspicion of tracheal disruption or mediastinal damage secondary to a posterior dislocation necessitates evaluation by a capable thoracic surgeon.

MEDICATION

Section 7 of 11  

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The goal of therapy is to reduce inflammation and to minimize severe pain. To achieve this goal, anti-inflammatory agents and analgesics are the drugs of choice (DOCs).

Drug Category: Analgesics

These agents commonly are used for the relief of mild to moderate pain. Pain control is essential to quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and enable physical therapy regimens. Most analgesics have sedating properties that are beneficial for patients with injuries. Although the effects of NSAIDs in the treatment of pain tend to be patient specific, ibuprofen is usually the DOC for the initial therapy. Other NSAIDs may be considered.

Drug Name	Naproxen (Aleve, Anaprox, Naprelan, Naprosyn)
Description	For relief of mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing the activity of the enzyme cyclooxygenase, which results in a decrease of prostaglandin synthesis.
Adult Dose	500 mg PO, followed by 250 mg PO q6-8h; not to exceed 1.25 g/d
Pediatric Dose	<2 years: Not established >2 years: 2.5 mg/kg/dose PO; not to exceed 10 mg/kg/d
Contraindications	Documented hypersensitivity; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency; high risk of bleeding
Interactions	Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; monitor PT closely (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently
Pregnancy	B - Usually safe but benefits must outweigh the risks.
Precautions	Category D in third trimester of pregnancy; acute renal insufficiency, interstitial nephritis, hyperkalemia, hyponatremia, and renal papillary necrosis may occur; patients with preexisting renal disease or compromised renal perfusion risk acute renal failure; leukopenia occurs rarely, is transient, and usually returns to normal during therapy; persistent leukopenia, granulocytopenia, or thrombocytopenia warrants further evaluation and may require discontinuation of drug

Drug Name	Ketoprofen (Orudis, Oruvail, Actron)
Description	For relief of mild to moderate pain and inflammation. Administer small dosages initially to patients with a small body size, elderly persons, and those with renal or liver disease. When administering this medication, doses >75 mg do not increase therapeutic effects. Administer high doses with caution, and closely observe patients for response.
Adult Dose	25-50 mg PO q6-8h prn; not to exceed 300 mg/d
Pediatric Dose	<3 months: Not established 3 months to 12 years: 0.1-1 mg/kg PO q6-8h >12 years: Administer as in adults
Contraindications	Documented hypersensitivity; GI disease; cardiovascular disease; renal or hepatic impairment; patients receiving anticoagulants
Interactions	Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; monitor PT closely (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently
Pregnancy	B - Usually safe but benefits must outweigh the risks.
Precautions	Category D in third trimester of pregnancy; caution in congestive heart failure, hypertension, and decreased renal and hepatic function; caution in anticoagulation abnormalities or during anticoagulant therapy

Drug Name	Acetaminophen (Tylenol, Aspirin Free Anacin, Feverall)
Description	DOC for pain in patients with documented hypersensitivity to aspirin or NSAIDs, in those with upper GI disease, or in those who are taking oral anticoagulants.
Adult Dose	325-650 mg PO q4-6h or 1000 mg tid/qid; not to exceed 4 g/d
Pediatric Dose	<12 years: 10-15 mg/kg/dose PO q4-6h prn; not to exceed 2.6 g/d >12 years: 325-650 mg PO q4h; not to exceed 5 doses in 24 h
Contraindications	Documented hypersensitivity; documented G-6-PD deficiency
Interactions	Rifampin can reduce analgesic effects of acetaminophen; coadministration with barbiturates, carbamazepine, hydantoins, and isoniazid may increase hepatotoxicity
Pregnancy	B - Usually safe but benefits must outweigh the risks.
Precautions	Hepatotoxicity possible in chronic alcoholism following various dose levels; severe or recurrent pain or high or continued fever may indicate a serious illness; acetaminophen is contained in many OTC products and combined use with these products may result in cumulative acetaminophen doses exceeding recommended maximum dose

Drug Name	Propoxyphene and acetaminophen (Darvocet N-100)
Description	Drug combination indicated for mild to moderate pain.
Adult Dose	1-2 tabs PO q4h prn; not to exceed 600 mg/d
Pediatric Dose	Not established
Contraindications	Documented hypersensitivity
Interactions	May increase the serum concentrations of MAOIs, tricyclic antidepressants, carbamazepine, phenobarbital, and warfarin
Pregnancy	C - Safety for use during pregnancy has not been established.
Precautions	Caution in patients dependent on opiates (substitution may result in acute opiate withdrawal symptoms); caution in severe renal or hepatic dysfunction

Drug Name	Acetaminophen with codeine (Tylenol with codeine)
Description	Drug combination indicated for treating mild to moderate pain.
Adult Dose	30-60 mg/dose PO based on codeine content q4-6h or 1-2 tab q4h; not to exceed 12 tab/d
Pediatric Dose	Recommended dose based on codeine: 0.5-1 mg/kg/dose PO Recommended based on acetaminophen: 10-15 mg/kg/dose PO q4h; not to exceed 2.6 g/24 h of acetaminophen
Contraindications	Documented hypersensitivity
Interactions	Toxicity increases with CNS depressants or tricyclic antidepressants
Pregnancy	C - Safety for use during pregnancy has not been established.
Precautions	Caution in patients dependent on opiates since this substitution may result in acute opiate withdrawal symptoms; caution in severe renal or hepatic dysfunction

Drug Name	Hydrocodone and acetaminophen (Lorcet, Vicodin)
Description	Drug combination indicated for relieving moderate to severe pain.
Adult Dose	1-2 tab or cap PO q4-6h prn pain
Pediatric Dose	Do not exceed the following doses of hydrocodone bitartrate: <2 years: 1.25 mg/dose PO 2-12 years: 5 mg/dose PO >12 years: 10 mg/dose PO
Contraindications	Documented hypersensitivity; high-altitude cerebral edema or elevated intracranial pressure
Interactions	Coadministration with phenothiazines may decrease analgesic effects; toxicity increases with CNS depressants or tricyclic antidepressants
Pregnancy	C - Safety for use during pregnancy has not been established.
Precautions	Tabs contain metabisulfite, which may cause hypersensitivity; caution in patients dependent on opiates since this substitution may result in acute opiate withdrawal symptoms; caution in severe renal or hepatic dysfunction

Drug Name	Oxycodone and acetaminophen (Percocet)
Description	Drug combination indicated for relieving moderate to severe pain.
Adult Dose	1-2 tab or cap PO q4-6h prn pain
Pediatric Dose	0.05-0.15 mg/kg/dose PO; not to exceed 5 mg/dose of oxycodone q4-6h prn
Contraindications	Documented hypersensitivity
Interactions	Phenothiazines may decrease analgesic effects of this medication; toxicity increases with coadministration of either CNS depressants or tricyclic antidepressants
Pregnancy	C - Safety for use during pregnancy has not been established.
Precautions	Duration of action may increase in elderly patients; be aware of total daily dose of acetaminophen patient is receiving (do not exceed 4 g/d of acetaminophen; higher doses may cause liver toxicity)

FOLLOW-UP

Section 8 of 11  

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• Follow-up
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Further Inpatient Care

• Inpatient admission may be necessary for patients with posterior SCJ dislocations or for patients in need of treatment of associated injuries.

Further Outpatient Care

• Reductions performed in the ED require stabilization of the affected shoulder with a soft figure-of-eight dressing, a commercial clavicular harness, or secure sling. Maintain immobilization for at least 4 weeks.
• To ensure adequate healing of sprains, arrange for a follow-up visit to the appropriate physician.
• For anterior/posterior dislocations, a follow-up visit with a qualified physician is indicated to determine the need for further treatment (eg, elective reduction, internal fixation) and to evaluate functional capacity.

In/Out Patient Meds

• Analgesics and anti-inflammatory agents

Transfer

• Patients thought to have sustained additional major injuries, either because of the force of the mechanism of injury or because of documented presence of serious associated wounds (eg, pneumothorax, tracheal injury, venous compromise), may require retriage to a trauma center.
• Issues of patient stability and transfer benefit need to be addressed based on the clinical setting and available resources.
• Patients with posterior SCJ dislocation and/or potential complications may benefit from transfer to a facility with thoracic and orthopedic consultation services.

Complications

• Approximately 25% of posterior SCJ dislocations are associated with tracheal, esophageal, or great vessel injury and may involve the following specific complications:
• • Tracheal rupture or erosion
  • Pneumothorax
  • Laceration of the superior vena cava
  • Occlusion of the subclavian artery and/or vein
  • Recurrent dislocation
  • Decreased range of motion
  • Residual swelling or deformity

Prognosis

• Most patients have adequate upper extremity function following sternoclavicular joint injuries.
• The prognosis depends on such factors as extent and type of joint damage, activity level, and concomitant medical illness of the patient.

Patient Education

• Patients with sprains should initially restrict activity involving the affected extremity.
• Anterior/posterior dislocations
• • Patients should restrict activity and follow up as instructed.
  • Patients with posterior dislocations who are discharged home should return for medical care if they exhibit symptoms of mediastinal injury.

MISCELLANEOUS

Section 9 of 11  

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• Workup
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• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

Medical/Legal Pitfalls

• Failure to diagnose posterior dislocation and its potential complications
• Failure to detect coexistent injuries (ie, additional injuries due to the mechanism of injury)
• Failure to consider life-threatening referred etiologies of shoulder and sternoclavicular pain, such as myocardial infarction and rupture of the spleen

Special Concerns

• Pregnancy
• • The need for radiographs outweighs the radiation risk to the fetus.
  • Use appropriate shielding.
• Pediatric patients
• • The medial clavicular epiphysis may not be radiographically apparent until age 18 years and may not close until age 25 years. It is the last physis to close.
  • Many presupposed sternoclavicular dislocations are actually fractures through the physeal plate.
  • Separation of the clavicular physis in adolescents suggests a Salter-Harris type I or type II fracture.
• Elderly patients
• • In older patients, anterior dislocations may transpire without any clear history of trauma. This most commonly manifests as a painless mass over the medial aspect of the clavicle.
  • In geriatric or less active younger patients, anterior dislocations may be left unreduced and still permit adequate range of motion.

MULTIMEDIA

Section 10 of 11  

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• Follow-up
• Miscellaneous
• Multimedia
• References

Media file 1:  Superior mediastinal contents may be threatened in posterior dislocations of the sternoclavicular joint.
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Media file 2:  CT scan of a left sternoclavicular dislocation demonstrates anterior and superior displacement of the clavicle from its normal articulation with the manubrium. The right sternoclavicular joint is normal.
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Media type:  CT

Media file 3:  CT scan of a left sternoclavicular dislocation demonstrates anterior and superior displacement of the clavicle from its normal articulation with the manubrium. The right sternoclavicular joint is normal.
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Media type:  CT

Media file 4:  CT scan of a left sternoclavicular dislocation demonstrates anterior and superior displacement of the clavicle from its normal articulation with the manubrium. The right sternoclavicular joint is normal.
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Media type:  CT

Media file 5:  This 80-year-old woman presented 1 week after a fall because of persistent pain and discoloration in the anterior part of her chest. Certain movements of her right arm were especially painful though not incapacitating. Note the extensive ecchymosis of the anterior part of her thorax and the swelling of the right upper parasternal/lower anterior neck area. The right sternoclavicular joint area was tender and edematous to palpation. Same patient as in Images 6-8.
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Media file 6:  The right sternoclavicular joint appears edematous on lateral inspection. Palpation confirms the apparent anterior dislocation. Same patient as in Images 5 and 7-8.
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Media file 7:  Comparison of the normal left sternoclavicular joint emphasizes the abnormalities. Same patient as in Images 5-6 and 8.
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Media file 8:  The patient refused further workup and treatment beyond a temporary sling, stating that the injury had not significantly affected her lifestyle. She was discharged home in the company of her daughter with over-the-counter analgesics. Same patient as in Images 5-8.
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Media type:  Photo

REFERENCES

Section 11 of 11

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

• Bicos J, Nicholson GP. Treatment and results of sternoclavicular joint injuries. Clin Sports Med. Apr 2003;22(2):359-70. [Medline].
• Brinker MR, Simon RG. Pseudo-dislocation of the sternoclavicular joint. J Orthop Trauma. Mar-Apr 1999;13(3):222-5. [Medline].
• Cope R. Dislocations of the sternoclavicular joint. Skeletal Radiol. 1993;22(4):233-8. [Medline].
• Ernberg LA, Potter HG. Radiographic evaluation of the acromioclavicular and sternoclavicular joints. Clin Sports Med. Apr 2003;22(2):255-75.
• Friedman RS, Perez HD, Goldstein IM. Septic arthritis of the sternoclavicular joint due to gram-positive microorganisms. Am J Med Sci. Sep-Oct 1981;282(2):91-3. [Medline].
• Garretson RB 3rd, Williams GR Jr. Clinical evaluation of injuries to the acromioclavicular and sternoclavicular joints. Clin Sports Med. Apr 2003;22(2):239-54. [Medline].
• Gobet R, Meuli M, Altermatt S, et al. Medial clavicular epiphysiolysis in children: the so-called sterno-clavicular dislocation. Emerg Radiol. Apr 2004;10(5):252-5. [Medline].
• Marker LB, Klareskov B. Posterior sternoclavicular dislocation: an American football injury. Br J Sports Med. Mar 1996;30(1):71-2. [Medline].
• McCulloch P, Henley BM, Linnau KF. Radiographic clues for high-energy trauma: three cases of sternoclavicular dislocation. AJR Am J Roentgenol. Jun 2001;176(6):1534. [Medline].
• Noda M, Shiraishi H, Mizuno K. Chronic posterior sternoclavicular dislocation causing compression of a subclavian artery. J Shoulder Elbow Surg. Nov-Dec 1997;6(6):564-9. [Medline].
• Rockwood CA. Dislocation of the sternoclavicular joint. In: Fractures in Adults. Vol 1. 1975:756-787.
• Thomas DP, Davies A, Hoddinott HC. Posterior sternoclavicular dislocations--a diagnosis easily missed. Ann R Coll Surg Engl. May 1999;81(3):201-4. [Medline].
• Torretti J, Lynch SA. Sternoclavicular joint injuries. Curr Opin Orthop. 2004;15(4):242-7.
• Tsai DW, Swiontkowski MF, Kottra CL. A case of sternoclavicular dislocation with scapulothoracic dissociation. AJR Am J Roentgenol. Aug 1996;167(2):332. [Medline].
• Uehara DT, Rudzinski JP. Injuries to the shoulder complex and humerus. In: Tintinalli JE, et al, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York: McGraw-Hill;2004: 1695-1702.
• Yeh GL, Williams GR. Conservative management of sternoclavicular injuries. Orthop Clin North Am. Apr 2000;31(2):189-203. [Medline].

Article Last Updated: Jan 25, 2007