Sternoclavicular dislocation: Difference between revisions

Revision as of 23:30, 9 February 2012

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

Authors:

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 ==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
-SC joint is freely movable synovial joint
+==Diagnosis==
+*CT
-Allows movement in nearly all planes
+**Study of choice (plain films may not be diagnostic)
+**Consider IV contrast if concern for injury to mediastinal structures
-Very strong/stable due to connective tissue stabilizers - dislocation is UNCOMMON
-Requires substantial force to dislocate
-Anterior dislocation:posterior ratio 9:1
-==Mechanism==
-Anterior: anterior blow to lateral shoulder levers medial clavicle out
-Poster: usually direct blow to medial clavicle
-==Presentation==
-Anterior
--usually not subtle
--can happen in elderly without significant trauma
--minimal potential for resultant morbidity
-Posterior
-Associated with sig force
-% incidence of mediastinal injury
--tracheal rupture
--PTX
--SVC lac
--Subclavian occlusion
--Vocal cord palsy
-==Imaging==
-Rountine Xray may appear nl
-Serendipity View: 40˚ from vertical, direct cephalad
-CT modality of choice
--can demonstrate co-injuries
-MRI/MRA if necessary
 ==Treatment==
-===Anterior===
+===Sprain===
--Reduction if you desire
+*Rice, sling, analgesics
+===Anterior Dislocation===
--Bolster between shoulder blades, abduct arm to 90˚, press medial clavicle posteriorly and inferiorly
+*May d/c without attempted reduction (no impact on function)
+*Clavicular splinting, ice, analgesics
--May not reduce 2/2 interposed ligaments
+*Ortho referral
+===Posterior Dislocation===
--May not stay reduced 2/2 loss of ligament support
+*May be assoc w/ life-threatening injuries:
+**PTX, compression/laceration of surrounding great vessels, trachea, or esophagus
--Sling
+*Consult ortho for closed reduction (ideally performed in the OR)
--Ortho f/u
-===Posterior===
--Difficult to reduce
--Prep, place towel clips, pull anteriorly while (assistant) placing traction and abduction to ipsilateral arm
--Sling
--Ortho f/u
--Admit if other mediastinal injury
 ==Source==
+*Tintinalli
-Perron (ACEP '09)
 [[Category:Ortho]]