Shoulder Injury – Hockey

Abstract

0412 HISTORY: A 13-year-old youth hockey player sustained a blow to his right shoulder during an attempted check. He missed his opponent hitting the boards directly with his right shoulder. There was immediate onset of sharp pain in the lateral aspect of his shoulder and also in the sternoclavicular region. He was assisted from the ice and transported to a local emergency room. Referred to sports medicine center for suspected acromioclavicular joint dislocation. PHYSICAL EXAMINATION: Evaluation revealed a teenager in a significant amount of distress. Posture was significant for forward protracted shoulders and a flexed neck position. The right upper extremity was self-splinted close to his body. Palpation revealed exquisite tenderness at the right sternoclavicular joint and medial clavicle. There was also swelling in the region of the right sternoclavicular joint. The right acromioclavicular joint was non-tender. Range of motion of the shoulder was diffusely restricted secondary to pain. Cervical spine range of motion was essentially full in all planes. He was able to activate all upper extremity muscle groups with normal strength. Finger flexors, finger extensors, wrist flexors, wrist extensors, and interossei were all normal. Rotator cuff muscle groups demonstrated normal strength. Upper extremity reflexes were normal. Sensation to light touch was intact in the axillary, median, ulnar, and radial nerve distributions. There was a strong radial pulse and excellent capillary refill. DIFFERENTIAL DIAGNOSIS: Sternoclavicular joint dislocation Clavicle fracture Acromioclavicular joint dislocation Sternum contusion TEST AND RESULTS: Right clavicle/shoulder radiographs: Normal CT of bilateral sternoclavicular joints with 2D sagittal and coronal reconstruction and 3D model: Study demonstrated a 1.2-cm posterior dislocation of the right clavicular head at the sternoclavicular joint. The posterior aspect of the medial right clavicular head was 3mm anterior to the traversing segment of right brachiocephalic artery and approximately 5mm from the traversing segment of right brachiocephalic vein. FINAL WORKING DIAGNOSIS: Right posterior sternoclavicular joint dislocation TREATMENT AND OUTCOMES: Gentle physical therapy, ROM Unsuccessful attempt at closed reduction – operating room Open reduction and internal fixation of right sternoclavicular joint Three month follow-up, return to full activity level, playing baseball