Sternoclavicular Joint Injury Workup

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

Imaging Studies

Routine radiographs of the sternoclavicular joint are often difficult to interpret and may falsely appear normal. [11, 12, 13]

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 dem 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 dem 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 dem 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.

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

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

Bedside ultrasound may be used to evaluate boney contours and structural alignment, and the sternoclavicular joint space, a small hypoechoic area, may be identified between the clavicle and sternum. Adjacent vascular structures and their flow may be assessed, and the presence of a hemothorax or pneumothorax may also be diagnosed. Typically, a high frequency (7-13) MHz linear-array probe is used, aligned parallel to the clavicular long axis. [14, 15]