SHOULDER GIRDLE INJURY - WRESTLING

Abstract

1774 HISTORY - 14 year old male presenting with an acute injury to his left shoulder girdle. He was engaged in wrestling when his left arm was internally rotated at the side and pushed cephalad. There was a "pop" in his shoulder with subsequent pain and limitation in range of motion. He denies any significant past medical or surgical history and also reports no previous shoulder injuries. PHYSICAL EXAMINATION - Asymmetry was noted with acute swelling and point tenderness at the left sternoclavicular (SC) joint. Palpation along the line of the left clavicle demonstrated an inferior placement when compared with the right. His cardiovascular and pulmonary exams were within normal limits. Peripheral neurovascular status in his upper extremities was intact. There was discomfort and limited range of motion of the arm in all directions. Patient was placed in a sling and sent for radiographs before being referred to Sports Medicine clinic. DIFFERENTIAL DIAGNOSIS 1. Anterior sternoclavicular dislocation 2. Clavicular fracture 3. Posterior sternoclavicular dislocation TESTS AND RESULTS: RADIOGRAPHS Clavicular anterior-posterior - no fractures noted Left SC joint - PA and oblique views: 4 mm space at the SC junction Cephalic tilt view of the SC joint - medial end of the left clavicle elevated above the right clavicle FINAL WORKING DIAGNOSIS Anterior sternoclavicular dislocation TREATMENT 1. Clavicular reduction - patient was in a supine position while longitudinal and posterior traction were applied to his left arm. Distraction and cephalad pressure assisted in the reduction of the clavicle. There was immediate improvement in pain and range of motion. 2. Arm sling for comfort for the next 3-5 days with active range of motion exercises twice a day. 3. Avoid stress across the SC joint for the next 3-6 weeks.