Sternoclavicular Joint Injury
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Basics
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
- 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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Basics
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
- 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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