Sternoclavicular Joint Injury
Basics
Description
Description
- Sternoclavicular joint (SCJ) is the only joint that connects the upper limb to the trunk
- Among the least frequently injured joints in the body
- Most commonly due to athletic or vehicular injuries
- Congenital or spontaneous dislocation and subluxation are rarely seen
- SCJ stability depends on ligamentous attachments, primarily anterior and posterior sternoclavicular ligaments, interclavicular ligament, and costoclavicular ligament
- Diagnosis of injury or dislocation requires a high suspicion
Etiology
Etiology
- Injury to the SCJ can be from sprains, subluxations, or dislocations of the ligamentous structure
- In sprains, ligamentous capsule remains intact
- Subluxation occurs when sternoclavicular ligament ruptures while costoclavicular ligament remains intact
- Complete ligamentous disruption leads to dislocation
- The SCJ can dislocate anteriorly or posteriorly. A large force is required. A greater force is required to displace the clavicle posteriorly
- Dislocations may be more common in patients with hypermobility syndromes such as Ehlers–Danlos syndrome
- Direction of dislocation depends on the shoulder position:
- Anterior dislocation more likely when the acromion is posterior to the manubrium
- Posterior dislocation more likely when the acromion is anterior to the manubrium
- Anterior dislocation is more common (more than 90% of dislocations):
- Caused by a posteriorly directed force to the anterolateral aspect of the shoulder
- Reciprocal anterior displacement of the medial clavicle
- May be associated with pneumothorax, hemothorax, pulmonary contusion, or rib fractures
- Subluxation and dislocation may occur spontaneously
- Posterior SCJ dislocation results from:
- Anterior-to-posterior blow to the medial clavicle
- Anteriorly directed force to the lateral aspect of the ipsilateral shoulder
- A blow to the contralateral shoulder when the injured side is braced against an immobile object
- Posterior dislocation is a surgical emergency:
- Indications for immediate reduction:
- Compression or tear of trachea, esophagus, or great vessels
- Recurrent laryngeal nerve injury
- Indications for immediate reduction:
Pediatric Considerations
- The medial epiphyseal growth plates of the clavicles are last to ossify, and fuse between ages 22 and 25:
- Until fusion, growth plate is the weakest part of the joint
- Fractures through the medial epiphysis mimic SCJ dislocations:
- Most commonly Salter–Harris type I or II fractures
- True dislocations of the SCJ are extremely rare in children because of strong ligamentous attachments
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Citation
Schaider, Jeffrey J., et al., editors. "Sternoclavicular Joint Injury." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307582/all/Sternoclavicular_Joint_Injury.
Sternoclavicular Joint Injury. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307582/all/Sternoclavicular_Joint_Injury. Accessed December 11, 2024.
Sternoclavicular Joint Injury. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307582/all/Sternoclavicular_Joint_Injury
Sternoclavicular Joint Injury [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 11]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307582/all/Sternoclavicular_Joint_Injury.
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