Sternoclavicular Joint Injury Follow-up

  • Author: John P Rudzinski, MD, FACEP; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Mar 9, 2011
 

Further Inpatient Care

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

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.
Previous
Next

Inpatient & Outpatient Medications

  • Analgesics and anti-inflammatory agents
Previous
Next

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 transfer to an advanced facility such as 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.
Previous
Next

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
Previous
Next

Prognosis

  • Most patients have adequate upper extremity function following sternoclavicular joint injuries.[11]
  • The prognosis depends on such factors as extent and type of joint damage, activity level, and concomitant medical illness of the patient.
Previous
Next

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.

Previous
 
Contributor Information and Disclosures
Author

John P Rudzinski, MD, FACEP  Clinical Professor of Surgery and Internal Medicine, University of Illinois College of Medicine, Rockford; Vice Chairman, Department of Emergency Medicine, Rockford Memorial Hospital

John P Rudzinski, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Daniel J Dire, MD, FACEP, FAAP, FAAEM  Clinical Professor, Department of Emergency Medicine, University of Texas Medical School at Houston; Clinical Professor, Department of Pediatrics, University of Texas Health Sciences Center San Antonio

Daniel J Dire, MD, FACEP, FAAP, FAAEM is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American Academy of Pediatrics, American College of Emergency Physicians, and Association of Military Surgeons of the US

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

David B Levy, DO, FACEP, FAAEM  Chairman, Department of Emergency Medicine, St Elizabeth Health Center; Associate Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine

David B Levy, DO, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Informatics Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

  1. Torretti J, Lynch SA. Sternoclavicular joint injuries. Curr Opin Orthop. 2004;15(4):242-7.

  2. Tsai DW, Swiontkowski MF, Kottra CL. A case of sternoclavicular dislocation with scapulothoracic dissociation. AJR Am J Roentgenol. Aug 1996;167(2):332. [Medline].

  3. 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].

  4. 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].

  5. Ernberg LA, Potter HG. Radiographic evaluation of the acromioclavicular and sternoclavicular joints. Clin Sports Med. Apr 2003;22(2):255-75.

  6. 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].

  7. Brinker MR, Simon RG. Pseudo-dislocation of the sternoclavicular joint. J Orthop Trauma. Mar-Apr 1999;13(3):222-5. [Medline].

  8. Yeh GL, Williams GR. Conservative management of sternoclavicular injuries. Orthop Clin North Am. Apr 2000;31(2):189-203. [Medline].

  9. 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].

  10. MacDonald, P., Lapointe, P. Acromioclavicular and Sternoclavicular Joint Injuries. Orthopedic Clinics of North America. 10/08;39:[Full Text].

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

  12. 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].

  13. 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].

  14. Van Hofwegen C, Wolf B. Suture repair of posterior sternoclavicular physeal fractures: a report of two cases. Iowa Orthop J. 2008;28:49-52. [Medline].

 
Previous
Next
 
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.
Superior mediastinal contents may be threatened in posterior dislocations of the sternoclavicular joint.
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.
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.
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.
The right sternoclavicular joint appears edematous on lateral inspection. Palpation confirms the apparent anterior dislocation.
Comparison of the normal left sternoclavicular joint emphasizes the abnormalities.
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.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.