On examination, there was localized tenderness along with a prominent palpable bump just lateral to the sternum on the left side(Figure 1). Sternoclavicular joint; sternoclavicular joint dislocation; sternoclavicular joint reconstruction; suture technique. Dislocations of the sternoclavicular joint (SCJ) occur with relative infrequency and can be classified into anterior and posterior dislocation, with the former being more common. The https:// ensures that you are connecting to the 2022 Apr 11;23(1):350. doi: 10.1186/s12891-022-05293-x. The posterior and anterior sternoclavicular ligaments, costoclavicular ligament, interclavicular ligament, and the strong joint capsule that surround the SCJ provide it with durable stability. Dislocation of joints in the human body is a common occurrence, with the upper limb being commonly involved in most dislocations. She denies any complaints of respiratory distress or upper extremity paresthesias. Posterior dislocations are treated with closed reduction, which is successful in most cases. Following CT scan of the chest, the next step in management is, Nonsurgical management and follow-up CT scan in 6 weeks, Closed reduction in the emergency room under sedation, Closed reduction in the operating room under general anesthesia with thoracic surgery on standby, followed by immobilization for 4 weeks, Closed reduction in the operating room under general anesthesia with thoracic surgery on standby, followed by compression plating, Open reduction in the operating room under general anesthesia, followed by transarticular pinning with K-wires. The shoulder is composed of the humerus, scapula, and clavicle, and it has four different joints, which are the glenohumeral, acromioclavicular, sternoclavicular, and scapulothoracic joints .The shoulder is stabilized by two types of factors, passive and active. Asymmetrical bilateral sternoclavicular joint dislocation combined with bilateral clavicular fracture: a case report, Anterior sternoclavicular dislocation associated with clavicular fracture: a case report and review of the literature, Double trouble!!! sharing sensitive information, make sure youre on a federal What is the most appropriate treatment at this time? At four-weekfollow-up, the patient was fine with the maintenance of the reduction in alignment and negligible tenderness at the injury site(Figure 3). : r/Fitness. While all registered Cureus users can rate any published article, the opinion of domain experts is weighted appreciably more than that of non-specialists. A 33-year-old female is diagnosed with spontaneous atraumatic subluxation of the sternoclavicular joint. He had also sustained a contused lacerated wound (CLW) of 2 mm x 2 mm on the dorsal surface of his left thumb. However, if the closed reduction is a success, it has similar functional outcomes to the open reduction[14]. Sternoclavicular Dislocations are uncommon injuries to the chest that consist of traumatic or atraumatic dislocations of the sternoclavicular joint. Accessibility Copyright 2023 Lineage Medical, Inc. All rights reserved. Orthop Surg. Accessibility Sometimes,the physical findings are subtle, and diagnosis will depend on imaging studies. Ngom G, Mohamed AS, El Housseine MO, Ndour O. Pan Afr Med J. government site. The https:// ensures that you are connecting to the The authors report the case of a10 years old child, received at emergencies for right shoulder blunt trauma after been punched by another child. PMC The posterior SC dislocations are more worrisome because of the important structures that are located just behind the sternum. Digital radiograph of the chest showing successful maintenance of reduction of the left, MeSH The joint is located in the spot where the clavicle (collarbone) meets the sternum (breastbone) at the base of the neck. Anterior and posterior sternoclavicular dislocations are described based on the position of the clavicle in relationship to the sternum. Six types of anterior dislocations were listed, including 4 recent and 2 old ones. Nine patients had serious concomitant injuries. . "Never doubt that a small group of thoughtful, committed citizens can change the world. All registered users are invited to contribute to the SIQ of any published article. Heavy activity in the form of bench press in the gym has also been reported [10]. Fifteen-degree clavicular hook plate achieves better clinical outcomes in the treatment of acromioclavicular joint dislocation. Terra BB, Rodrigues LM, Pdua DV, Martins MG, Teixeira JC, De Nadai A. Rev Bras Ortop. See this image and copyright information in PMC. Signs Common to Both Anterior and Posterior Injuries The patient has severe pain that is increased with any movement of the arm, particularly when the shoulders are pressed together by a lateral force. They took a decision to proceed with the closed reduction maneuver and the dislocation was reduced as described above. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. The sternoclavicular joint (SCJ) is an inherently unstable diarthrodial joint between the manubrium of the sternum and clavicle which obtains stability from ligamentous support. Two additional drill holes, the first in manubrium and the second in clavicle were performed from the anterior cortex to the posterior between the previous bone tunnels. This is attributed to a combination of restricted range of movements and strong ligaments around it. Anterior dislocation is nine times more frequent than posterior dislocation[1]. The sternoclavicular joint is the most frequently . (OBQ13.53) FOIA FOIA Clinical picture showing the prominent bump just lateral to the sternum (black arrow). -, Sewell MD, AlHadithy N, Le Leu A, et al Instability of the sternoclavicular joint: current concepts in classification, treatment and outcomes. She notes mild, intermittent pain and a small amount of prominence to that area. Our patient remembers the exact incidence of events of the injury in whichhe jumped from a height of approximately 4 meters followed by a wall collapsing on him. (B) The lever effect was taken to press the medial end of the clavicle down for reduction by the hook plate. Painless range of motion and stability of the . However, closed reduction is successful in only 38% of attempts[12], and despite successful closed reduction, residual instability often remains. Am J Sports Med, 2014, 42: 25172524. Bethesda, MD 20894, Web Policies The first metacarpal shaft fracture was fixed with open reduction and internal fixation using a lag screw (10 mm x 2 mm). 2014 Dec 17;19:386. doi: 10.11604/pamj.2014.19.386.5684. The view of choice for SCJ dislocation is the serendipity view, which shows asymmetry in the sternal ends of the clavicles [3,10]. According to the ASES scoring system, the postoperative physical function had a mean of 94.8. Bookshelf Balser Plate Stabilization for Traumatic Sternoclavicular Instabilities or Medial Clavicle Fractures: A Case Series and Literature Review. -, Asymmetrical bilateral sternoclavicular joint dislocation combined with bilateral clavicular fracture: a case report. X-rays were taken to confirm that John has an anterior sternoclavicular joint dislocation. This site needs JavaScript to work properly. The diagnosis may be obvious from the findings of a clinical examination, which reveal local tenderness and prominence of the sternal end of the clavicle. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. Jt Dis Relat Surg. They are usually stable following closed reduction, They require fusion to hold the reduction, They are rarely symptomatic when left unreduced, They should be treated acutely with medial clavicle excision. Treatment is generally observation of atraumatic or chronic anterior dislocations. Before 8600 Rockville Pike This view, looking down on the body from above, shows how the clavicle shifts towards the front of the body with an anterior dislocation. Anterior sternoclavicular joint dislocation (SCJ) is a relative rare injury, related to high energy trauma. A firefighter by profession, he had sustained a fall from approximately a height of 4 meters while on active duty. The objective of the present study is to present a novel suture technique for treatment of anterior SCJ traumatic dislocation and to report clinical outcomes from a small case series undergoing this procedure. Under general anesthesia, the patient was lying supine with a bolster firmly placed between his shoulders. Li G, Liu T, Shao X, Liu Z, Duan J, Akileh R, Cao S, Jin D. J Int Med Res. eCollection 2016 Apr 18. Unable to load your collection due to an error, Unable to load your delegates due to an error. and transmitted securely. A thorough search of literature revealed a handful of cases of sternoclavicular dislocation. HHS Vulnerability Disclosure, Help Results: Injuries range from a separated shoulder resulting from a fall onto the shoulder to a high-speed car accident that fractures the shoulder blade (scapula) or collar bone (clavicle). Background: Sternoclavicular joint (SCJ) instability is relatively rare. Bethesda, MD 20894, Web Policies 2013;23 Suppl 2:082. - Anterior SC Dislocation: - more common than posterior dislocation; - closed reduction is usually not successful; - persistent prominence is usually present but not of functional significance; - atraumatic dislocation: - no specific treatment is required, as the natural history . Would you like email updates of new search results? But the imaging studies highly dependon thepositioning of the limb. The .gov means its official. Regardless of whether the dislocation is anterior or posterior, there are characteristic clinical findings of sterno-clavicular joint dislocation. Epub 2020 Sep 6. can be occult or subtle on radiographs. Successful reduction of the SCJ dislocation was confirmed clinically as well as under fluoroscopy. J Emerg Med. Shoulder appears shortened and rolled forward. A careful examination of the sternoclavicular joint may aid in delineation of the direction of injury. Analogous to the sternal side of the clavicle, two vertical bone tunnels were drilled from the anterior cortex towards the posterior cortex. Anterior sternoclavicular joint dislocation (SCJ) is a relative rare injury, related to high energy trauma. 2019 The Authors. sharing sensitive information, make sure youre on a federal and Digital radiograph of the chest, Figure 3. This site needs JavaScript to work properly. J Shoulder Elbow Surg, 2002, 11: 4347. After 17months, the internal fixations of the patient in Fig. Anterior SCJ dislocations account for almost 3% of all shoulder girdle injuries but only 1% of all joint dislocations [1-3]. Though the diagnosis of anterior SCJ dislocation is obvious with its clinical finding, a high degree of suspicion and astute clinical acumen are also needed since it can be missed in the setting of polytrauma. A joint is the articulation, or connection point, between two or more bones that are held together by a . According to the American Shoulder and Elbow Society (ASES) scoring system . Conclusion: World J Orthop. A 3-D computed tomography image is shown in Figure A. My lifts are going up just as predicted and I'm feeling good. To evaluate the safety and efficacy of using acromioclavicular joint hook plates for the treatment of anterior sternoclavicular joint dislocation. Visualization of the SCJ on plain radiographs can be technically challenging due to the anatomical complexity of the region. Bookshelf Almost immediately, he complained ofsevere pain and swelling. There were no complications, no wound infections, and no plate or screw breakages. A rapid diagnosis followed by efficient treatment is needed to avoid future complications[5]. The CLW was thoroughly debrided. The objective of the present study is to present a novel suture technique for treatment of anterior SCJ traumatic dislocation and to report clinical outcomes from a small case series undergoing this procedure. official website and that any information you provide is encrypted This link will take you to a third party website that is not affiliated with Cureus, Inc. The final follow up was 28.2 months. Injury to the SCJ is uncommon and generally presents from a high energy traumatic impact. 2016 Apr 18;7(4):244-50. doi: 10.5312/wjo.v7.i4.244. However, there are still some deficiencies that need to be improved. Balser Plate Stabilization for Traumatic Sternoclavicular Instabilities or Medial Clavicle Fractures: A Case Series and Literature Review. and transmitted securely. BMJ Case Rep. 2021 Mar 10;14(3):e237164. J Pediatr Orthop. Mohapatra A, Choudhury P (January 05, 2022) Anterior Dislocation of the Sternoclavicular Joint A Case Report. Dislocation of joints in the human body is a common occurrence, with the upper limb being commonly involved in most dislocations. (A) An anterosuperior straight incision was extended from the medial clavicle to the midsuperior aspect of the sternal manubrium. . anterior, closed reduction, left upper limb, sternoclavicular joint, reducible dislocation, Published: [Short-term effectiveness of reconstructive locked plate for treating sternoclavicular joint dislocation]. (BD) Functional outcome 17months after the first surgery. There were 3 recent posterior forms. Keywords: We present this case to highlight the rarity of this unusual dislocation and also shed light on its etiopathogenesis and current management trends. A polysling was applied to the left upper limb for 4-6 weeks, and the patient was called for fortnightly follow-up. Although not common, problems with the SC joint can arise from injury and other disorders. Because most anterior dislocations have a minimal long-term functional impact on quality of life, non-operative management is typically recommended, but the decision is made at the . (OBQ06.5) According to the American Shoulder and Elbow Society (ASES) scoring system, the preoperative physical function had a mean of 83.5. Tytherleigh-Strong G, Sabharwal S, Peryt A. (see history), Cite this article as: Learn more here. Introduction: Anterior sternoclavicular joint dislocation (SCJ) is a relative rare injury, related to high energy trauma. 2013 Dec;27(12):1450-2. There has been an ongoing debate about whether anterior dislocation warrants reduction. This force causes the lateral end of the clavicle backwards whilst rotating the . If the patient is under 25 then the possibility of a physeal injury should also be considered[11]. Federal government websites often end in .gov or .mil. The SCJ is inherently unstable due to its lack of articular contact and therefore relies on stability from surrounding ligamentous structures, such as the . Human subjects: Consent was obtained or waived by all participants in this study. Disclaimer, National Library of Medicine Epub 2020 Sep 6. A series of trauma radiographs were carried out, which confirmed our suspicion of anterior dislocation of the left SCJ (Figure 2). Despite the common occurrence of upper limb dislocations, sternoclavicular dislocation is rare, comprising just 1% of all dislocations seen. -, Tepolt F, Carry PM, Heyn PC, et al Posterior sternoclavicular joint injuries in the adolescent population: a metaanalysis. Imaging reveals a posterior sternoclavicular dislocation. eCollection 2015 Jul-Aug. World J Orthop. Please note that Cureus is not responsible for any content or activities contained within our partner or affiliate websites. Please enable it to take advantage of the complete set of features! At final follow-up (none of the patients had experienced any symptoms of instability of SCJ, no side-to-side difference was observed, while the Mean QuickDASH score was 4.85. FOIA 2016;7:244250. The prerequisite for causing SCJ dislocation is a powerful force of vector, which can only be seen during high-energy trauma like road traffic accidents (RTA), sporting accidents, or falls from height[3]. Photo showing right-sided sternoclavicular displacemnt. This site needs JavaScript to work properly. We suspected a fracture of the sternal end of the left clavicle or an anterior dislocation of the left SCJ. Computed tomography (CT) scan with three-dimensional reconstruction has become the choice of imaging in doubtful SCJ dislocations[4]. The purpose of this study was to describe an SCJ ligament reconstruction technique and retrospectively evaluate its safety and effectiveness for treating . Bakir MS, Lefering R, Haralambiev L, Kim S, Ekkernkamp A, Gmbel D, Schulz-Drost S. Sci Rep. 2020 Dec 10;10(1):21606. doi: 10.1038/s41598-020-78754-9. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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Before often occult clinically. However, more research is desirable to compare different techniques and to conclude to the optimal surgical treatment. Figure 17: Anterior sternoclavicular dislocation. Severe pain that is exacerbated by arm motion and lying supine. Anything above 5 should be considered above average. Disclaimer, National Library of Medicine Anterior SC joint dislocations occur nine times more often than posterior . Posterior dislocation of the SCJ occurs if there is application offorce directly over the anteromedial aspect of the clavicle or if the posterolateral shoulder undergoes an indirect force thereby forcing the sternal clavicle posteriorly. A thorough search of literature revealed a handful of cases of sternoclavicular dislocation. Am J Sports Med. By joining Cureus, you agree to our Despite the common occurrence of upper limb dislocations, sternoclavicular dislocation is rare, comprising just 1% of all dislocations seen. Superior sternoclavicular joint dislocation presented with shoulder motion limitation: A case report and literature review. 2020 Dec;12(6):1627-1634. doi: 10.1111/os.12726. Kalantar SH, Bagheri N, Bidaki M, Vosoughi F. Int J Surg Case Rep. 2021 May;82:105887. doi: 10.1016/j.ijscr.2021.105887. A missed diagnosis can be fatal[4]. Reduction and fixation were performed with hook plates in all 10 patients. A . An official website of the United States government. Digital radiograph showing the dislocation, Figure 2. Radiological examination had limited diagnostic value. sharing sensitive information, make sure youre on a federal eCollection 2014. The injury can be broadly categorized into two types based on the direction of medial clavicular displacement: anterior. Published: January 05, 2022. Closed versus open reduction is indicated for acute dislocations. She is noted to have 6 points out of a possible 9 points on the Beighton-Horan scale. Evaluation and Management of Sternoclavicular Dislocation in the Emergency Department. Clinical Features. Feng WL, Cai X, Li SH, Li ZJ, Zhang K, Wang H, Zhang J, Zhu YJ, Feng DX. government site. Mohapatra A, Choudhury P (January 05, 2022) Anterior Dislocation of the Sternoclavicular Joint A Case Report. Federal government websites often end in .gov or .mil. HHS Vulnerability Disclosure, Help A thorough search of . Anterior dislocations can be closed reduced, though many are unstable even after reduction. An official website of the United States government. Epub 2021 Jun 11. [1-4] Even isolated SC dislocations are rare injuries and account for only 3% of all dislocations around the shoulder. The reported technique for SCJ reconstruction in traumatic anterior SCJ dislocations with two sutures has theoretical advantages, since it stabilizes the SCJ in the antero-posterior, as well as the supero- inferior direction. (A) The postoperative Xray image showed that the sternoclavicular joints were still stable after the removal of internal fixation. posteriorly-directed impact on the anteromedial . 2021;32(2):560-565. doi: 10.52312/jdrs.2021.135. SCJ dislocations are rare and should be investigated properly. Prior to this I've lifted 2x a week and for the past 7 months I've been a regular CrossFit attendee. Dislocationof joints in the human body is a common occurrence, with the upper limb being commonly involved in most dislocations. MeSH The long-term follow-up results of 13 patients with traumatic anterior sternoclavicular dislocations are described. 2013. One thing is certain: everyone injures his or her shoulder at some point in life. 2003;22:219237. Anterior sternoclavicular joint dislocation (SCJ) is a relative rare injury, related to high energy trauma. CT studies are generally required to assess for direction of displacement. Clipboard, Search History, and several other advanced features are temporarily unavailable. Traumatic posterior sternoclavicular joint dislocation in a child: a case report. An official website of the United States government. The .gov means its official. (C) The intraoperative fluoroscopy showed that the dislocation was reduced successfully by the hook plate. Yi JW, Kim DH, Heo YM, Jun JB. CT studies are generally required to assess for direction of displacement. He was brought to the hospital an hour after his fall and was conscious and oriented with no neurovascular deficit. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. 95% of SCJ dislocations are unilateral and anterior dislocations are far more common than posterior dislocations due to the weaker anterior sternoclavicular ligament (ratio 9:1). Careers. There is a myriad of surgical techniques for coracoclavicular (CC) joint reconstruction in the setting of acute acromioclavicular (AC) joint Rockwood type III or V dislocations, and the controversy of optimal treatment, especially for Rockwood type III injuries, continues. If SCJ dislocation presents within eight to 10 days of injury, it can be reduced successfully. An articles SIQ will appear alongside the article after being rated twice and is recalculated with each additional rating. Arch Orthop Trauma Surg. Open reduction should be carried out for unsuccessful cases of relocation or for re-dislocation cases. Diagnosis can be made with plain serendipity radiographic views. Movement of the shoulder girdle was improved in all patients. medially-directed impact on the lateral shoulder 8. posterior. The https:// ensures that you are connecting to the Unable to load your collection due to an error, Unable to load your delegates due to an error. Despite the common occurrence of upper limb dislocations, sternoclavicular dislocation is rare, comprising just 1% of all dislocations seen. The site is secure. less serious. A 35-year-old man presented to our emergency department (ED) with complaints of pain and swelling in the upper portion of his left chest and left hand. The patients had a mean age of 36.2 (SD 17.9) years. Anyone had one? You can rate this topic again in 12 months. Clinical picture showing the prominent. Cureus 14(1): e20974. (OBQ06.4) This must have caused the generation of powerful force of vector required. The sternoclavicular joint can dislocate from its normal position. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. This is attributed to a combination of restricted range of movements and strong ligaments around it. Epub 2018 Aug 9. The site is secure. The objective of the present study is to present a novel suture technique for treatment of anterior SCJ traumatic dislocation and to report clinical outcomes from a small case series undergoing this procedure. Sternoclavicular dislocations account for 3% of all shoulder girdle injuries. Digital radiograph showing the dislocation of the sternoclavicular joint with separation between the, Figure 3. official website and that any information you provide is encrypted Physical examination usually shows that the end of the collarbone is very prominent on the injured side if it is an anterior dislocation, and the athlete will be very tender at that location. Sternoclavicular joint dislocation and its management: A review of the literature. Inman VT, Abbott LRC. It has been reported that closed reduction has poor results with a high failure rate of maintaining reduction and requires a subsequent second operation[13]. Diagnosis would help to see anterior forms from posterior forms. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. Nonoperative treatment with a sling and swathe for six weeks, Nonoperative treatment with immediate active range of motion of the shoulder, Open reduction and pinning of his medial clavicular physeal injury, Reduction in the operating room with thoracic surgery back-up, Shoulder360 The Comprehensive Shoulder Course 2023, Type in at least one full word to see suggestions list, 2017 Orthopaedic Summit Evolving Techniques, Pro: Modern Surgery Techniques: Dive In - Michael D. McKee, MD, FRCS, Reduction Posterior Sternoclavicular Dislocation - Everything You Need To Know - Dr. Nabil Ebraheim, Question SessionSternoclavicular Dislocation & Adult Pyogenic Vertebral Osteomyelitis. 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