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Sternoclavicular Joint Injury Medication

  • Author: John P Rudzinski, MD, FACEP; Chief Editor: Trevor John Mills, MD, MPH  more...
 
Updated: Nov 24, 2015
 

Medication Summary

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).

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Analgesics

Class Summary

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.

Propoxyphene products were withdrawn from the United States market on November 19th, 2010. The withdrawal was based on new data showing QT prolongation at therapeutic doses. For more information, see the FDA MedWatch safety information.

Ibuprofen (Motrin, Advil, Nuprin)

 

In the absence of contraindications, this is usually the DOC for treating mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

Naproxen (Aleve, Anaprox, Naprelan, Naprosyn)

 

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.

Ketoprofen (Orudis, Oruvail, Actron)

 

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.

Acetaminophen (Tylenol, Aspirin Free Anacin, Feverall)

 

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.

Acetaminophen with codeine (Tylenol with codeine)

 

Drug combination indicated for treating mild to moderate pain.

Hydrocodone and acetaminophen (Lorcet, Vicodin)

 

Drug combination indicated for relieving moderate to severe pain.

Oxycodone and acetaminophen (Percocet)

 

Drug combination indicated for relieving moderate to severe pain.

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Contributor Information and Disclosures
Author

John P Rudzinski, MD, FACEP Clinical Professor of Surgery, Department of Surgery, Clinical Professor of Medicine, Department of Internal Medicine, University of Illinois College of Medicine; Visiting Professor, American University of the Caribbean; Vice-Chairman, Emergency Department, Director of Medical Education, Rockford Health System; Staff Physician, Emergency Department, Rockford Memorial Hospital

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

Disclosure: Nothing to disclose.

Coauthor(s)

Alina Perez University of Illinois College of Medicine at Rockford

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

David B Levy, DO, FAAEM Senior Consultant in Emergency Medicine, Waikato District Health Board, New Zealand; Associate Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine

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

Disclosure: Nothing to disclose.

Chief Editor

Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine

Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Additional Contributors

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 Pediatrics, American Academy of Emergency Medicine, American College of Emergency Physicians, Association of Military Surgeons of the US

Disclosure: Nothing to disclose.

References
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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.
 
 
 
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