Sternoclavicular Joint Injury Workup

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

Imaging Studies

Routine radiographs of the sternoclavicular joint are often difficult to interpret and may falsely appear normal.[5, 6, 7]

A specialized view, known as the serendipity view and described by Rockwood (1975), may reveal the medial clavicle position. For this technique, the beam is tilted to 40° from vertical and directed cephalad through the manubrium of the patient while in a supine position. Normal clavicles should appear in the same horizontal plane, while anterior and posterior dislocations appear above and below the plane, respectively.

In the Hobbs view, the patient sits at the radiography table and leans forward so that the anterior chest is in contact with the film cassette and the flexed elbows straddle the cassette and support the patient. The x-ray beam is aimed directly down through the cervical spine, projecting the sternoclavicular joints onto the film cassette.

CT scan is an excellent technique to study problems of the sternoclavicular joint. Request inclusion of both sternoclavicular joints and the medial half of both clavicles on the CT scan so the injured side can be compared with the noninjured side. In addition to revealing the position of the medial clavicle, CT scan provides important information about the vital tissues of the superior mediastinum, which may be concomitantly injured.

See the images below.

CT scan of a left sternoclavicular dislocation demCT 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 demCT 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 demCT 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.

Other imaging studies, such as angiography or esophagoscopy, may be indicated when mediastinal injuries from a posterior dislocation are suspected.

MRI provides the same information as a CT scan while better documenting the soft tissue anatomy and associated mediastinal structures, but availability is often limited for emergency patients.

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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].

 
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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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