Posterior Sternoclavicular Joint Dislocation Research Articles

Posterior sterno-clavicular joint dislocation in a young male: a case report

Posterior sterno-clavicular joint dislocation in a young male: a case report

The sternoclavicular joint: a review of anatomy, injury and management

The sternoclavicular joint is the only true joint connecting the upper limb with the axial skeleton and is reliant on its capsular and ligamentous attachments for stability. Injuries to the sternoclavicular joint are uncommon and include sprains, dislocations, and fractures. Dislocations and medial clavicle fractures are often associated with high-energy trauma and can lead to life-threatening complications secondary to mediastinal injuries, particularly with posterior sternoclavicular joint dislocations. Given the rarity of these injuries, there are multiple case reports and retrospective studies detailing novel surgical techniques for managing injuries of the sternoclavicular joint and no single option has been implemented. We conducted a literature search on Medline, EMBASE and CINAHL to identify relevant articles focusing on sternoclavicular joint dislocation and subluxation, and medial clavicle fractures in adults. This review article aims to describe: the anatomy of the sternoclavicular joint; injuries including dislocation and medial clavicle fractures; and current investigation and management options including closed and open reduction techniques.

Posterior sternoclavicular dislocation in a 15-year old boy: case report

Posterior sternoclavicular joint dislocation is a very rare injury, representing less than 5% of all shoulder girdle injuries. While anterior dislocations may be treated non-operatively, posterior dislocations should either be reduced closed or open and fixed. In cases of concomitant injuries to the mediastinal structures, an open reduction is mandatory. We present a case of a 15-year old boy who presented with a posterior sternoclavicular joint dislocation without concomitant injuries in whom we have performed a chest X-ray but a computerised tomography was needed for a definitive diagnosis. An open reduction and cerclage with 3 non-absorbable sutures provided a stable fixation and the patient remained free of symptoms during the follow-up period.

Figure of Eight FiberTape Stabilization for Acute Posterior Sternoclavicular Joint Dislocation

Figure of Eight FiberTape Stabilization for Acute Posterior Sternoclavicular Joint Dislocation

The Floating Clavicle: Surgical Technique for Management of an Ipsilateral Acromioclavicular and Sternoclavicular Joint Dislocation

Bipolar “floating” clavicle injuries are infrequent upper-extremity injuries that occur secondary to a high-energy trauma, which can cause dislocation at the sternoclavicular (SC) and acromioclavicular joints. Given the rarity of this injury, there is not a consensus regarding clinical management. Although anterior dislocations can be managed nonoperatively, posterior dislocations may pose a threat to chest-wall structures and typically are managed surgically. Here, we present our preferred technique for concomitant management of a locked posterior SC joint dislocation with associated grade 3 acromioclavicular joint dislocation. Reconstruction of both ends of the clavicle was performed in this case, using a figure-of-8 gracilis allograft and nonabsorbable suture reconstruction for the SC joint, and an anatomic acromioclavicular joint and coracoclavicular ligament reconstruction with semitendinosus allograft and nonabsorbable suture.

Reconstruction of posterior dislocation of the sternoclavicular joint with nonabsorbable No. 5 ethibond sutures

Posterior sternoclavicular joint dislocation (PSCJD) is rare. It is usually due to contact sports or trauma and is often associated with multiple life-threatening complications. We report a case of a Kabaddi player (an Indian contact sport) who was pushed by an opponent and fell on his right shoulder. The patient complained of right shoulder pain and visible deformity over the right sternal area. After initial X-rays, the right posterior dislocation of the sternoclavicular joint was confirmed with computed tomography scan. After the attempts of closed reduction failed, open reduction and internal fixation were done with a double loop of No. 5 ethibond sutures. Excellent results can be achieved in PSCJD using open reduction and reconstruction techniques with double-stranded 5.0 ethibond nonabsorbable sutures.

Traumatic Left Posterior Sternoclavicular Joint Dislocation with Figure of 8 Semitendinosus Ligament Reconstruction

Traumatic Left Posterior Sternoclavicular Joint Dislocation with Figure of 8 Semitendinosus Ligament Reconstruction

Surgical Treatment of Traumatic Posterior Sternoclavicular Joint Dislocation: А Case Report.

Posterior sternoclavicular joint dislocation is a rare condition. In this paper, we present a 51-year-old male patient who was admitted to the emergency department in our hospital after he was hit by a mining railway wagon in the chest. A diagnosis of posterior sternoclavicular dislocation was confirmed after performing a CT scan. Following necessary preparations, the sternoclavicular joint was stabilized with two wire cerclage techniques during open reduction. During control at the postoperative 4th week, the range of motion at the shoulder was satisfactory, but the patient had mild pain at the joint level and was sent to physical therapy to improve the range of motion and to minimize the pain.

Sternoclavicular Joint Reconstruction with Semitendinosus Allograft and Suture Anchors after Recurrent Posterior Dislocation in a Professional North American Football Player

Background: Posterior sternoclavicular joint dislocations are an extremely rare but potentially life-threatening injury that can occur in sports. A variety of surgical procedures have been proposed, but there is no consensus on the treatment of choice. It is also largely unknown if a safe return to high-risk sports is possible. Case Presentation: We present a case of a posterior sternoclavicular joint dislocation in a 22-year-old male professional North American football player who had a recurrent irreducible posterior dislocation after initial injury management by closed reduction. The patient’s desire to return to football presented unique challenges to management. His sternoclavicular joint was subsequently reconstructed with semitendinosus allograft in a figure-of-eight augmented with suture anchors. After recovery, he returned to play as a running back in professional football symptom-free. Conclusion: Our patient's successful return to playing professional football after the sternoclavicular joint reconstruction suggests that this should be considered an effective treatment option when managing posterior sternoclavicular dislocation in high level contact sports players.

Clinical Outcomes and Return to Sports After Open Reduction and Hamstring Tendon Autograft Reconstruction in Patients With Acute Traumatic First-Time Posterior Dislocation of the Sternoclavicular Joint

Background: Traumatic posterior dislocations of the sternoclavicular joint (SCJ) are rare. Multiple case reports, case series, and systematic reviews have been published on the treatment of posterior SCJ dislocations. However, they have usually been of small numbers, described a variety of surgical techniques on a mixture of acute and chronic dislocations, and have not focused on functional recovery or return to sports. Purpose/Hypothesis: The purpose of this study was to assess the clinical outcomes and return to sports after SCJ open reduction and reconstruction using a hamstring tendon autograft in patients with an acute first-time traumatic posterior dislocation of the SCJ. We hypothesized that SCJ open reduction and reconstruction would result in high survivorship, good clinical outcomes, and a high rate of return to sports. Study Design: Case series; Level of evidence, 4. Methods: This study included all patients who underwent SCJ open reduction and reconstruction within 14 days of sustaining a first-time traumatic posteriorly dislocated SCJ, with a minimum 3-year follow-up. Patient-reported outcomes were assessed by the following scores: short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), Rockwood SCJ, modified Constant, and Single Assessment Numeric Evaluation (SANE). Survivorship was defined as no clinical failure, such as instability or recurrent dislocation, and no revision surgery. Return to sports was assessed using a customized questionnaire. Results: A total of 19 patients who underwent surgery were included, with a mean age of 30.8 years (range, 18-52 years). Seventeen patients were available at final follow-up at a mean 94.5 months (range, 37-155 months). At final follow-up, the mean scores were as follows: QuickDASH, 4.3 (range, 0-20.4); Rockwood, 13.9 (range, 12-15); modified Constant, 94.4 (range, 71-100); and SANE, 92.1 (range, 70-100). The construct survivorship was 96%. Of the 14 patients who participated in sports, 12 (86%) returned to their preinjury levels. Conclusion: After an acute first-time traumatic posterior SCJ dislocation, open reduction and stabilization with a hamstring tendon autograft, undertaken within 14 days of injury, provides good clinical outcomes and high rates of survivorship and return to sports.

Posterior sternoclavicular joint dislocation, a rare but "dangerous" injury.

A 17 years of age male patient presented with pain and movement restriction of right upper-extremity after a fall from his bicycle. On examination local swelling, tenderness, and depression of the medial end of the clavicle were present. Any attempt of shoulder movement was causing excruciating pain in this area. There was no other apparent injury and apart from the above-mentioned symptoms and clinical findings, all patients' vital signs were normal. No prominent fracture or other pathology were noticed on X-rays. The clinical findings were compatible with an injury of the sternoclavicular joint; a posterior sternoclavicular joint (SCJ) dislocation in particular. Posterior dislocation of the SCJ can be associated with injuries of the structures that lie behind the manubrium resulting in life threatening complications such as neurovascular, tracheal and oesophageal injuries. Therefor prompt diagnosis and treatment is required. Based on the clinical findings, a computed tomography (CT) was performed and the clinical suspicion was confirmed (A,B). The dislocation was reduced under general anesthesia by closed means, followed by arm immobilization.

Techniques for Reduction and Fixation of the Sternoclavicular Joint.

This video demonstrates the relevant anatomy, approach, and surgical techniques for reduction and fixation of the sternoclavicular joint in both the acute and chronic settings. Fixation techniques demonstrated include transosseous suture fixation, figure-of-eight autograft/allograft fixation, and transarticular plating. A step-by-step guide is provided with demonstration video on cadaveric specimens for each technique, along with a case example that demonstrates acute reduction and fixation of a posterior sternoclavicular joint dislocation.

Migrated posterior sternoclavicular joint dislocation into the mediastinum along with clavicle diaphyseal fracture in a child

Migrated posterior sternoclavicular joint dislocation into the mediastinum along with clavicle diaphyseal fracture in a child

A rare case of posterior sternoclavicular joint dislocation in a motorcycle rider

A rare case of posterior sternoclavicular joint dislocation in a motorcycle rider

Clinical Outcomes and Complications Following Surgical Management of Traumatic Posterior Sternoclavicular Joint Dislocations: A Systematic Review.

Traumatic posterior sternoclavicular joint dislocations are rare orthopaedic emergencies. Treatment typically consists of closed reduction, with surgical management reserved for unstable cases. Because of the low prevalence of this condition, limited clinical evidence exists for a superior surgical stabilization technique. A systematic review of the literature following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. MEDLINE and Embase databases were searched using a comprehensive search strategy. A descriptive and critical analysis of the results was performed. Forty relevant studies (108 cases) were identified. Favorable subjective and objective outcomes were reported for all 5 categories of stabilization described. The overall complication rate was 16%, including 4 cases of recurrent instability. Ligament reconstruction using tendon graft had the lowest recurrent instability and complication rates, and open reduction and internal fixation techniques required a second operation for implant removal in 80% of cases. A comprehensive review of the surgical management of traumatic posterior sternoclavicular joint dislocations is presented. Results suggest favorable outcomes for all of the methods of stabilization, with a modest complication rate. The trends observed have helped to guide the development of clinical care recommendations that aid in treatment decision-making for these injuries. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Posterior sternoclavicular joint dislocation; Rare but life-threatening

Posterior sternoclavicular joint dislocation; Rare but life-threatening

Figure-of-8 Reconstruction Technique for Chronic Posterior Sternoclavicular Joint Dislocation

Dislocation of the sternoclavicular joint is a rare injury and typically requires high-energy forces applied through the joint. Initial treatment is dependent on the direction of dislocation, with acute reduction indicated for posterior dislocations presenting with signs of tracheal, esophageal, or neurovascular compression. Although most patients do well with conservative treatment after the initial trauma, some can have persistent pain and scapular dyskinesia due to instability or locked dislocation of the sternoclavicular joint. Stabilization of the sternoclavicular joint with reconstruction may be indicated for those with persistent symptoms despite a trial of steroid injections and physical therapy. In this report and video, we present a figure-of-8 reconstruction technique to reduce and stabilize a posterior dislocation of the sternoclavicular joint using a gracilis autograft. Ultimately, this reconstruction technique can be performed in a safe, efficient, and reliable manner when appropriate surgical steps are followed.

Sternoclavicular Injury - Rugby Union (15-players-a-side)

HISTORY: A 19-year-old men’s college Rugby-15s winger collapsed during match play. The player had no impact with another player, dizziness and no loss of consciousness. A medical history revealed the player had sustained a right clavicular injury in a previous match 25 days prior to this incident. Where he complained of right shoulder pain, after impacting the ground with a multi-player tackle. The player had presented to an Urgent Care facility after that injury and provisionally diagnosed with shoulder sprain -vs- pectoralis strain, placed in arm-sling and sent home on oral analgesics. Right shoulder radiographs at Urgent Care visit were read as normal. PHYSICAL EXAM: Exam in ED revealed slurred speech, and complaints of localized pain and tenderness on right medial clavicle. Right sternoclavicular joint pain on palpation. Limited upper extremity range of motion secondary to pain, no facial droop, decreased left sided upper and lower extremity sensation, reflexes and strength. Symmetrical radial pulses with brisk capillary refills. DIFFERENTIAL DIAGNOSIS: 1. Cervical Neck Injury 2. Stroke 3. Fracture Clavicle 4. Rib Fracture 5. Scapular Fracture 6. Sternal Fracture TEST AND RESULTS: Chest anterior-posterior radiographs: -abnormal right SCJ MRI Brain no contrast: -Large area/acute infarction. Mass effect of right lateral ventricle. No hydrocephalus. Midline shift 1-2mm. CT brain no contrast: -Right MCA infarction with right frontal/parietal lobes, insular cortex, thalamus, caudate nucleus, internal/external capsule, and lentiform nucleus. -Mass-effect on the right lateral and third ventricles. Increased midline shift 8mm. No hydrocephalus. Carotid Duplex: -Arteries bilaterally, normal velocities/waveforms. CT chest: -Right clavicular head dislocated posterior to the sternum, in the superior mediastinum. Subperiosteal hematoma around proximal right clavicle. FINAL/WORKING DIAGNOSIS: Missed posterior sternoclavicular joint dislocation with brachiocephalic artery compromise leading to hemiparesis TREATMENT AND OUTCOMES: 1. Surgical Emergency. Often missed on radiograph. 2. Open repair of brachiocephalic artery, right clavicular reduction/SCJ capsulorraphy with hamstring tendon allograft. 3. Patient recovered with left sided hemiparesis. No return to sport. Sponsor: NOCSAE.org

Sternoclavicular Injury - Rugby Union (15-players-a-side)

HISTORY: A 19-year-old men’s college Rugby-15s winger collapsed during match play. The player had no impact with another player, dizziness and no loss of consciousness. A medical history revealed the player had sustained a right clavicular injury in a previous match 25 days prior to this incident. Where he complained of right shoulder pain, after impacting the ground with a multi-player tackle. The player had presented to an Urgent Care facility after that injury and provisionally diagnosed with shoulder sprain -vs- pectoralis strain, placed in arm-sling and sent home on oral analgesics. Right shoulder radiographs at Urgent Care visit were read as normal. PHYSICAL EXAM: Exam in ED revealed slurred speech, and complaints of localized pain and tenderness on right medial clavicle. Right sternoclavicular joint pain on palpation. Limited upper extremity range of motion secondary to pain, no facial droop, decreased left sided upper and lower extremity sensation, reflexes and strength. Symmetrical radial pulses with brisk capillary refills. DIFFERENTIAL DIAGNOSIS: 1. Cervical Neck Injury 2. Stroke 3. Fracture Clavicle 4. Rib Fracture 5. Scapular Fracture 6. Sternal Fracture TEST AND RESULTS: Chest anterior-posterior radiographs: -abnormal right SCJ MRI Brain no contrast: -Large area/acute infarction. Mass effect of right lateral ventricle. No hydrocephalus. Midline shift 1-2mm. CT brain no contrast: -Right MCA infarction with right frontal/parietal lobes, insular cortex, thalamus, caudate nucleus, internal/external capsule, and lentiform nucleus. -Mass-effect on the right lateral and third ventricles. Increased midline shift 8mm. No hydrocephalus. Carotid Duplex: -Arteries bilaterally, normal velocities/waveforms. CT chest: -Right clavicular head dislocated posterior to the sternum, in the superior mediastinum. Subperiosteal hematoma around proximal right clavicle. FINAL/WORKING DIAGNOSIS: Missed posterior sternoclavicular joint dislocation with brachiocephalic artery compromise leading to hemiparesis TREATMENT AND OUTCOMES: 1. Surgical Emergency. Often missed on radiograph. 2. Open repair of brachiocephalic artery, right clavicular reduction/SCJ capsulorraphy with hamstring tendon allograft. 3. Patient recovered with left sided hemiparesis. No return to sport. Sponsor: NOCSAE.org

Point-of-Care Ultrasound Diagnosis of Posterior Sternoclavicular Joint Dislocation

BackgroundPosterior sternoclavicular dislocations can be challenging diagnostically, as traumatic force often happens to the lateral shoulder rather than directly to the sternoclavicular joint. Shoulder radiographs do not illustrate the sternoclavicular joint well, and can miss the diagnosis. This injury, however, has the potential for life-threatening complications due to proximity of mediastinal structures that might also be injured. Case ReportThe following case illustrates a delayed diagnosis of posterior sternoclavicular dislocation. It also shows how point-of-care ultrasound can diagnose a dislocation, confirm persistence of a dislocation diagnosis when patients are transported from a referring facility, as well as educate the patient and family. Why Should an Emergency Physician Be Aware of This?Point-of-care ultrasound can be used to rapidly diagnose posterior sternoclavicular dislocations and to provide patients education about their injury.