Sternoclavicular dislocation

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:

1. Bicos J, Nicholson GP. Treatment and results of sternoclavicular joint injuries. Clin Sports Med. 2003 Apr;22(2):359-70