Traumatology : Traumatology Dr. Mina Nasser Wagih
Undergraduated 3rd year,
Faculty of physical therapy .
Cairo Uni. Sternoclavicular joint injury Defination : 2 Sternoclavicular joint injury Defination The sternoclavicular joint is a saddle-like joint that links the arm to the torso and allows free movement of the collarbone (clavicle) in almost all planes. Sternoclavicular joint dislocation is the displacement of the clavicle from its normal position relative to the breast bone (sternum). Anterior sternoclavicular (SC) joint dislocation occurs when the medial end of the clavicle is pushed forward toward the outside of the chest from its normal position (anterior dislocation). Posterior (retrosternal dislocation) occurs when the clavicle is pushed backward into the chest. Direct trauma to the medial clavicle may result in a posterior SC dislocation with damage to the trachea, esophagus, thoracic duct, lung, or large blood vessels. Sternoclavicular joint injury Defination : 3 Sternoclavicular joint injury Defination Sternoclavicular dislocations usually require significant force; a traumatic dislocation commonly results from an indirect blow to the front of the shoulder (anterior shoulder) when the arm is held away from the body (abducted). Dislocation may also occur from congenital, degenerative, or inflammatory processes. Generalized ligamentous laxity may cause repeated SC dislocation or partial dislocation in the absence of trauma.(subluxation) Sternoclavicular joint Anatomy : 4 Sternoclavicular joint Anatomy The sternoclavicular joint, or SC joint, is the connection of the sternum (breastbone) to the clavicle (collarbone). This SC joint is uncommonly injured, but it can be problematic when an injury is sustained Sternoclavicular joint Classification : 5 Sternoclavicular joint Classification Anterior SC Dislocation: - more common than posterior dislocation; - closed reduction is usually not successful; - persistent prominence is usually present but not of functional significance; - atraumatic dislocation: - no specific treatment is required, as the natural history is relatively good; - traumatic dislocation: some patients may have pain and loss of function;- Posterior SC Dislocation: - rare injury; - medial end of the clavicle cannot be palpated; - be aware that soft tissue swelling may cause the false impression of an anterior dislocation; - may cause delayed venous congestion or tracheal erosion; - attempts should be made at closed reduction which are successful in many cases; - if closed reduction fails, then operative intervention is warrented Sternoclavicular joint Mechanism of injury : 6 Sternoclavicular joint Mechanism of injury Dislocations of the SC joint are usually the result of an injury to the shoulder. Most commonly, the outside/front of the shoulder is struck forcefully, and an anterior SC dislocation occurs. In some cases, a blunt force directly to the front of the chest can cause a posterior SC dislocation Sternoclavicular joint Dislocation : 7 Sternoclavicular joint Dislocation The sternoclavicular joint can dislocate from its normal position. The clavicle will either dislocate in front (an anterior SC dislocation) or behind (a posterior SC dislocation). The posterior SC dislocations are more worrisome because of the important structures that are just behind the sternum Sternoclavicular joint Clinical picture : 8 Sternoclavicular joint Clinical picture Sternoclavicular joint Diagnosis : 9 Sternoclavicular joint Diagnosis A SC injury can be difficult to see on a regular x-ray. A special projection, called a 'serendipity view' x-ray can help show the SC joint and if it is injured. If the SC joint appears to be injured, a CT scan is often performed to better evaluate the type of dislocation.
Symptoms of a SC dislocation depend on whether or not it is an anterior or posterior dislocation. In the case of an anterior SC dislocation, you can usually see the dislocated end of the clavicle. Patients have pain and swelling in this area. Sternoclavicular joint Signs : 10 Sternoclavicular joint Signs Patients with a posterior SC joint dislocation may have a subtle dimpling of the skin over the SC joint, as well as pain and swelling. In addition, patients can have difficulty breathing, painful swallowing, and abnormal pulses caused by compression of the trachea, esophagus, and blood vessels Sternoclavicular joint Complications : 11 Sternoclavicular joint Complications Anterior sternoclavicular joint dislocations usually do not cause serious complications, but may result in a permanent cosmetic deformity or decreased range of motion.
Posterior sternoclavicular joint dislocations, however, have a 25% complication rate including tracheal rupture, pneumothorax, laceration of the superior vena cava, occlusion of the subclavian artery and/or vein, and recurrent dislocations. ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ Sternoclavicular joint Treatment : 12 Sternoclavicular joint Treatment Sternoclavicular joint Conservative Treatment : 13 Sternoclavicular joint Conservative Treatment Simple sprains to the SC joint are treated symptomatically with a sling and anti-inflammatory medications. In the acute setting, a reduction of the SC joint can be attempted by sedating the patient and pulling gently on the arm. This may allow the SC joint to 'pop' back into position. Sternoclavicular joint Operative treatment : 14 Sternoclavicular joint Operative treatment Surgery to relocate the SC joint is considered for posterior SC dislocations, and some painful, symptomatic anterior SC dislocations. If closed reduction is not successful, then surgery may be done to relocate the SC joint and repair the damaged SC joint capsule.
When surgery is performed for a posterior SC Sternoclavicular joint Rehabilitation : 15 Sternoclavicular joint Rehabilitation The primary focus of rehabilitation is to control pain and regain function. The degree of immobility following the injury will determine the amount of supervised exercise needed to resume pre-injury activities. When indicated by the treating physician, mobilization of the shoulder may be initiated. THANK YOU : 16 THANK YOU Dr.Mina Nasser