Evolution of nonoperative treatment of atraumatic sternoclavicular dislocation

Abstract

Atraumatic sternoclavicular dislocation (ASCD) is an uncommon pathology that is mainly diagnosed in young adults. The aim of this study is to better describe the clinical picture of ASCD and to describe the results of a "wait-and-see" policy in these patients. All patients with ASCD who visited our department between 2011 and 2016 were retrospectively analyzed. A standardized clinical examination was used to evaluate the clinical picture. All patients were treated nonoperatively, and at latest follow-up, several parameters and standardized questionnaires (Nottingham Clavicle Score, Oxford Shoulder Score, Constant-Murley Score) were used to evaluate the outcome. In total, 23 patients (12 male, 11 female) were evaluated. The average age at diagnosis was 18.6 years. There was a significant difference (P < .001) in angle of dislocation during forward flexion (mean = 141°) compared with abduction (mean = 101°). At latest follow-up (average 46 months, range 14-113 months; standard deviation [SD] = 27), subluxations still occurred but were less frequent and less prominent relative to presentation at initial diagnosis in 19 of 23 patients. The chance of subjective improvement increased by 27% for each year of follow-up. High outcome scores of Nottingham Clavicle Score (mean score = 80, SD = 11), Oxford Shoulder Score (mean score = 44, SD = 4), and Constant-Murley Score (mean score = 83, SD = 11) were reported. In patients with ASCD, the clavicle subluxates earlier in abduction than in forward flexion. After a midterm follow-up, a "wait-and-see" policy does not resolve the subluxations. However, most patients displayed reduced frequency and severity of subluxations over their recovery period and showed excellent scores on shoulder questionnaires.