What Is Sternoclavicular Dislocation?

Dislocation of the sternoclavicular joint includes anterior dislocation with the inner end of the clavicle pointing upward and protruding forward, and posterior dislocation with the inner end of the clavicle protruding downward, protruding backward, or the clavicle head sliding inside the sternal stem. The sternoclavicular joint is one of the most stable joints in the human body, and dislocations are not common, accounting for only 3% of the total number of dislocations in the shoulder joint, which is similar to the incidence of posterior dislocation of the shoulder joint.

Basic Information

English name: sternoclavicular dislocation
Visiting department: orthopedics

Common causes: Caused by indirect violence
Common symptoms: Pain and swelling at the sternoclavicular joint, neck flexion forward and affected

Causes of sternoclavicular dislocation

Common causes of sternoclavicular dislocations are direct and indirect violence, and indirect violence is the main cause. Violence is usually transmitted from the lateral side of the shoulder or the abducted upper arm along the clavicle inward to the sternoclavicular joint, while pushing the inner end of the clavicle upward, forward or backward. The direction of sternoclavicular joint dislocation depends on the size of the violence and the injured posture. According to the dislocation direction, it can be divided into two types: anterior dislocation and posterior dislocation.

Clinical manifestation of sternoclavicular joint dislocation

Pain and swelling in the sternoclavicular joint, flexion of the neck forward and the affected side, any head-up and shoulder movement can induce pain, deep breathing, sneezing can aggravate the pain, joint deformity, relaxation of the medial end of the clavicle, tenderness (+) Dislocation showed that the medial end of the clavicle protruded forward and there was abnormal activity. When the clavicle head compresses the trachea and esophagus, it can cause suffocation and difficulty swallowing. Subcutaneous emphysema can occur if the lung tip is punctured, and the sternoclavicular joint is empty at palpation.

Examination of sternoclavicular joint

X-ray examination, it is best to take oblique or side X-rays, combined with trauma history diagnosis. Chest radiographs are often missed. In this case, a plain CT scan should be performed routinely, and at the same time, you can understand whether there are complications.

Diagnosis of sternoclavicular joint dislocation

There is usually a significant history of trauma. After the injury, local swelling and pain, limited shoulder movement, and bilateral sternoclavicular joints are asymmetric; those with anterior dislocation can see that the medial end of the clavicle is protruding and displaced, often accompanied by abnormal activity; those with posterior dislocation have local pain and swelling, However, the sternoclavicular joint was empty at palpation. Because the medial end of the clavicle is located on the back of the chest, it may cause breathing difficulties due to the compression of the trachea, or difficulty in swallowing and obstruction of blood circulation by compression of the esophagus and mediastinal vessels.

Dislocation of the sternoclavicular joint is common in car accidents and direct impact from heavy objects. Anyone with trauma or swelling or tenderness in the sternoclavicular joint due to anterior or shoulder trauma to the inner end of the clavicle should first consider dislocation of the sternoclavicular joint. A radiograph can confirm the diagnosis.

Treatment of sternoclavicular joint dislocation

Non-surgical treatment

(1) Mild injuries are mainly symptomatic treatment. The upper extremity is hanged with a triangle towel, and the first part is coldly applied with an ice pack within 24 to 36 hours, followed by hot compressing. Functional exercises are gradually carried out after 4 to 5 days, and it can be completely recovered in 10 to 14 days.

(2) Both subluxation and anterior dislocation can be closed and closed. Abduction traction is used to compress the proximal end of the clavicle by hand. After reduction, it is fixed with a front "8" plaster. Post-dislocation: Most post-dislocations can be closed with reduction. After local anesthesia, the patient lies on his back with a sandbag between his shoulder blades. The patient s upper arm is suspended outside the bed and pulled down by the assistant. When resetting, a sound is heard and the inside of the clavicle is immediately accessible. After resetting, the shoulder was fixed with "8" plaster bandages and removed after 6 weeks. If the manual reduction is unsuccessful, the proximal end of the clavicle can be clamped with towel forceps to reduce the tension.

2. Surgery

(1) Incision reduction and Kirschner wire internal fixation. Applicable to those who cannot be closed and reset and who have symptoms of trachea and esophageal compression after dislocation.

(2) Resection of the articular disc or medial segment of the clavicle. For patients with old dislocations, internal clavicle resection can be used. Any internal fixation method can affect joint activity and should not be applied. Chronic traumatic sternoclavicular joint is gradually dislocated forward, and only local elevation is needed without special treatment.