Sternoclavicular Joint Dislocation (2022)

Sternoclavicular joint dislocation is a relatively uncommon injury that can be easily missed or misdiagnosed. Bilateral posterior sternoclavicular joint dislocation is particularly uncommon.

The importance in determining the direction of dislocation is emphasised by the dichotomy of management. Hence, a thorough history and examination, especially looking for evidence of compression of retrosternal structures, is paramount. Specialised sternoclavicular X-ray views should be supplemented by CT/MRI if clinical suspicion is high. Posterior dislocations necessitate prompt orthopedic referral.

Case Report

A 30 year old man presented to ED with bilateral “shoulder pain” after a quad bike accident. The patient took acorner at high-speed landing heavily on his right shoulder and crushed by the bike landing on his left shoulder.

  • On presentation, ABCs were intact GCS 15 he ambulated into the department. He had no dysphonia, dysphagia or dyspnoea.
  • On examination – both right and left shoulders were dislocated anteriorly.
  • On arrival into the department and XR was performed and both shoulders relocated.
  • Subsequent examination revealedswelling and tenderness over both sternoclavicular joints and the patient was unable to abduct either shoulder actively despite glenohumeral enlocation. Passive movement of the shoulders was limited by pain “over the collarbone”, although the clavicles themselves were only tender near their junction with the sternum. Specifically, the AC joints and humerus were non-tender and arm neurovascular status was normal.

The Chest XR was reported as ‘normal’…

However in light of the high clinical suspicion for sternoclavicular joint injury; continued anterior chest pain and failure in shoulder abduction special plain film tomography views of both SC joints was performed:

(Video) Sternoclavicular joint Dislocations - Everything You Need To Know - Dr. Nabil Ebraheim

There is widening of the right sternoclavicular joint when compared to the left side. This appearance is suspicious for subluxation/dislocation. There is probable subtle widening of the left sternoclavicular joint as well. Several well-corticated bone ossicles are noted in the vicinity of the sternoclavicular joints bilaterally.

CT scan confirmed superior dislocation of bilateral sternoclavicular joints with associated fracture of the left 1st rib anteriorly

Anatomy of the sternoclavicular joint

  • The sternoclavicular joint is a diarthodial saddle-type joint which provides a pivot for the shoulder girdle on the trunk.
  • The joint capsule is reinforced anterioposteriorly by the anterior and posterior sternoclavicular ligaments. Superomedially the joint is reinforced by the interclavicular ligament which joins both the upper border of both clavicles to the suprasternal notch.
  • The clavicle is also bound to the first costal cartilage and the first rib by the costoclavicular ligament.
Sternoclavicular Joint Dislocation (3)

Clinical Presentation

Incidence

  • Sternoclavicular dislocations account for 3% of all shoulder girdle injuries.
  • 95% of SCJ dislocations are unilateral and anterior dislocations are far more common than posterior dislocations due to the weaker anterior sternoclavicular ligament (ratio 9:1). Bilateral superior dislocations, as in the case above, are rarely described.

Mechanism of Injury

(Video) Sternoclavicular Joint Dislocation Review - Everything You Need To Know - Dr. Nabil Ebraheim

  • Dislocations of the SCJ generally occur following a fall on the outstretched hand or a direct blow to the shoulder. Sporting injuries and motor vehicle accidents account for the most causes of SCJ dysfunction. However, they can also occur without any history of injury.
  • Patients commonly present with pain and swelling in the proximal sternum and sternoclavicular region. The pain will be exacerbated by lateral shoulder compression, arm movements, deep breathing or coughing.
  • Patients often laterally flex their neck towards the affected side to relieving pressure on the SCJ. Asymmetry is best appreciated when viewed from above the patient’s head.
  • Additional symptoms include dysphonia, dysphagia or dyspnoea.

Diagnostic Imaging

  • Plain X-ray: standard views may not provide a definitive diagnosis. Alternate views such as ‘serendipity view‘ (40-degree cephalic tilt) may provide more information.
  • CTA or MRA to determine direction of dislocation and potential for vascular compromise. A contrast study is required for definitive evaluation of surrounding structures.

Complications

Many complications have been reported in the literature related to retrosternal (posterior) dislocation of the medial end of the clavicle including:

Management

Simple sprain of the SCJ

  • Patients will complain of mild to moderate pain and there will be no joint instability on clinical examination.
  • Conservative treatment with ice, analgesia, shoulder sling for immobility will lead to complete recovery in 1 week.
  • Subluxation of the SCJ will require the application of a clavicular splint or sling for 3 to 6 weeks

Anterior SCJ Dislocations

  • Anterior sternoclavicular dislocations are usually managed nonoperatively.
  • The clavicle often stabilises in its subluxed position, with asymmetrical ventral protrusion of the affected side. The arm should be rested in a sling which will assist in the reduction of pain. Patients generally experience a good pain-free functional outcome at 2-3 weeks. Very rare complications include chronic pain, periarticular calcifications with ankylosis and progressive deformity.
  • Closed reduction may be indicated in rare circumstances where the patient is engaged in strenuous upper limb activities causing a painful SCJ. It is however, often unsuccessful. The application of direct pressure over the medial end of the clavicle may also reduce the joint.

Posterior SCJ Dislocations

  • Posterior sternoclavicular dislocations should always be reduced in theatre because of the associated risk to intrathoracic and superior mediastinal structures.

Methods of reduction

The initial treatment of choice is a closed reduction. Various methods have been described:

(Video) Sternoclavicular Joint Injuries - Everything You Need To Know - Dr. Nabil Ebraheim

  • Classical: Patient positioned supine with a towel/sandbag between scapulae. Sedation is administered and traction is applied to the abducted arm with simultaneous extension. This has an 80% success rate.
  • Buckerfield and Castle: While shoulders are pushed posteriorly by an assistant, the ipsilateral arm is adducted against the torso and caudal traction is applied.
  • Towel Clip: Anterior traction force can be applied to clavicle by percutaneously applied towel clip, often used with one of the above methods.
  • A figure of eight sling is applied after the reduction for 4-6 weeks to allow for ligamentous healing.

If the SCJ becomes chronically unstable or if closed reduction is unsuccessful, then open reduction is indicated.

Discussion

Traumatic sternoclavicular joint dislocation is an uncommon condition whose diagnosis is often missed. The importance in determining the direction of dislocation is emphasised by the dichotomy of management. The posterior version of this dislocation has been associated with multiple complications and owing to the rarity of this injury, there is a relative lack of familiarity with the diagnosis, surgical anatomy and treatment options. [Reference]

A thorough history and examination, especially looking for evidence of compression of retrosternal structures, is paramount. Specialised sternoclavicular X-ray views should be supplemented by CT/MRI if clinical suspicion is high. Posterior dislocations necessitate prompt orthopedic referral.

Example of a Unilateral Posterior Sternoclavicular Dislocation

References
  • Saltzman, M., Mercer, D., Bertelsen, A., Warme, W., & Matsen, III, F. (2009). Bilateral posterior sternoclavicular dislocations Radiology Case Reports, 4 (1) DOI10.2484/rcr.v4i1.256
  • Sewell MD et al. Instability of the sternoclavicular joint: current concepts in classification, treatment, and outcomes. Bone Joint J 2013; 95-B: 721-31. PMID23723264
  • Jacques B. Jougon, MD, Denis J. Lepront, MD, Claire E. H. Dromer, M. Posterior Dislocation of the Sternoclavicular Joint Leading to Mediastinal Compression. PMID 8572795
  • Deren ME et al. Posterior sternoclavicular dislocations: a brief review and technique for closed management of a rare but serious injury. Orthopedic Reviews 2014; 6: 5245. PMID: 24744842
  • Hoekzema N. Torchia M. Adkins M Cassivi SD.Posterior sternoclavicular joint dislocation PMID 18248716
  • Mirza AH, Alam K, Ali A Posterior sternoclavicular dislocation in a rugby player as a cause of silent vascular compromise: a case report. Br J Sports Med. 2005 May;39(5):e28.PMID15849281
  • Balcik BJ et al. Evaluation and treatment of sternoclavicular, clavicular, and acromioclavicular injuries. Prim Care Clin Office Pract 40 (2013): 911-923. PMID24209725
  • Asplund C, Pollard ME. Posterior sternoclavicular joint dislocation in a wrestler. Mil Med. 2004 Feb;169(2):134-6. PMID15040635
  • Wirth MA, Rockwood CA Jr. Acute and Chronic Traumatic Injuries of the Sternoclavicular Joint.J Am Acad Orthop Surg. 1996 Oct;4(5):268-278. PMID 10797194
  • Brinker MR, Bartz RL, Reardon PR, Reardon MJ. A method for open reduction and internal fixation of the unstable posterior sternoclavicular joint dislocation. J Orthop Trauma. 1997 Jul;11(5):378-81.PMID9294804
  • Saltzman, M., Mercer, D., Bertelsen, A., Warme, W., & Matsen, III, F. (2009). Bilateral posterior sternoclavicular dislocations Radiology Case Reports, 4 (1) DOI: 10.2484/rcr.v4i1.256
  • O’Connor PA. Nölke L. O’Donnell A. Maha Lingham A.Retrosternal dislocation of the clavicle associated with a traumatic pneumothorax PMID17669976
  • Cooper A. A treatise on dislocations and on fractures of the joints. In: Longman, Hurst, Orme, Brown, Green, eds. London, 1824:359
  • Gazak S, Davidson SJ. Posterior sternoclavicular dislocations: two case reports. J Trauma. 1984 Jan;24(1):80-2. PMID 6694232
  • ALIEM: Sternoclavicular Joint Dislocations: Diagnosis and Treatment

Mike Cadogan

Associate Professor Curtin Medical School, Curtin University. Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM Sir Charles Gairdner Hospital. Passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |

(Video) Posterior Sternoclavicular Dislocation reduction. - Everything You Need To Know - Dr. Nabil Ebraheim

FAQs

Is the sternoclavicular joint easily dislocated? ›

About Sternoclavicular Joint (SCJ) Dislocations

Injuries to the SCJ are rare, comprising less than 1% of all joint dislocations and only 3% of shoulder girdle injuries. The SCJ can be dislocated anteriorly or posteriorly.

What is sternoclavicular joint dislocation? ›

Sternoclavicular dislocation refers to complete rupture of all the sternoclavicular and costoclavicular ligaments. This occurs from a single, well-defined trauma most commonly a motor vehicle accident or collision sport such as rugby or American football. The force is typically indirect on the shoulder.

Can you dislocate the sternoclavicular joint? ›

Sternoclavicular joint dislocations are rare and represent only 3% of all dislocations around the shoulder[1]. Despite the uncommon nature of these injuries they can present the clinician with uncertainty regarding their investigation and management. Dislocations may be either traumatic or atraumatic.

How do you fix a dislocated sternoclavicular joint? ›

If you have a joint dislocation, your doctor may try to manipulate the clavicle back into place without making an incision in the skin. This procedure is called a closed reduction. A closed reduction is usually performed in the operating room. You may be given either general anesthesia or a muscle relaxant.

Why can't you fix a dislocated collarbone? ›

Sternoclavicular injuries are usually treated without surgery. Many doctors are not comfortable performing surgery on these types of injuries because of the risk to the neurovascular structures that are just behind this area in the neck.

How do I strengthen my SC joint? ›

Keep your arm straight, palm facing to the left and slowly lift your arm up in front of your body. Reach overhead as high as you comfortably can and then slowly lower your arm to the starting position. Repeat 10 times, switch the weight to your left hand and repeat the exercise.

How long does a sternoclavicular dislocation take to heal? ›

This is an injury to the joint between your collar bone and breast bone. Healing: It normally takes six weeks to heal, but symptoms can continue for three to six months.

What is a sternoclavicular injury? ›

STERNOCLAVICULAR (SC) SPRAINS. [Back] What is it? An SC sprain is an injury to the joint where the clavicle (collarbone) meets the sternum (breastbone). These injuries are rare, requiring an accident with a lot of force, such as a tackle in football or rugby.

What type of joint is sternoclavicular? ›

The sternoclavicular (SC) joint is a saddle-shaped, synovial joint that serves as the primary skeletal connection between the axial skeleton and the upper limb.

Why does my sternoclavicular joint pop? ›

In moderate sprains, the joint becomes unstable. In rare cases, patients have a stable joint but a painful clicking, grating, or popping feeling. This indicates an injury to the intra-articular disc ligament. This type of injury causes pain and problems moving the SC joint.

Why does my clavicle pop out? ›

Collarbone popping can be caused by problems with any of them. Injury, lax ligaments, or hypermobile joints are also possible causes. Get medical attention for popping caused by trauma, infection, or inflammation, or if you can't move your shoulder.

What does a dislocated collarbone feel like? ›

Intense pain as soon as the injury occurs. Tenderness of the shoulder and collarbone. Swelling. Bruising.

How do I put my clavicle back in place? ›

How to SELF Pop Your Collar Bone - YouTube

How do you tape a sternoclavicular joint? ›

How to Apply PF Performance Tape - Collarbone - YouTube

What to do if your collarbone is out of place? ›

Seek prompt medical attention for a broken collarbone. Most heal well with ice, pain relievers, a sling, physical therapy and time. But a complicated break might require surgery to realign the broken bone and to implant plates, screws or rods into the bone to hold the bone in place during healing.

Will my shoulder ever be the same after dislocation? ›

Some people tear ligaments, tendons and other tissues when they dislocate their shoulder. If these tissues have been damaged, you may need surgery to repair them. This can significantly reduce the chance of dislocating the same shoulder again in the future for some people.

When is clavicle surgery needed? ›

Specifically, surgery should be strongly considered if the fracture is shortened by 2 centimeters or more, displaced more than 100% (the fractured ends aren't touching at all), when there are specific fracture patterns (such as Z-type fractures), or when the fractures are highly comminuted (shattered).

Can you relocate a dislocated collarbone? ›

Surgery to relocate the SC joint is considered for posterior SC dislocations, and some painful, symptomatic anterior SC dislocations. If non-surgical repositioning of the joint is not successful, then surgery may be done to relocate the SC joint and repair the damaged SC joint ligaments.

What movements occur at the sternoclavicular joint? ›

Specifically, the movements of the sternoclavicular joint are sorted into three degrees of freedom; elevation - depression, protraction - retraction, and axial rotation.

Is sternoclavicular arthritis painful? ›

Patients may complain of pain about the medial aspect of the clavicle that may radiate into the shoulder. Patients report pain with activity, particularly overhead. Pain at rest and at night are often described.

Can a collar bone be adjusted? ›

Fortunately, a chiropractor has the knowledge and training to adjust the shoulder, work the surrounding muscles, and relieve you of the pain. This technique also applies to the collarbone and the humerus. Certain movements will allow these bones to become primary.

Can a dislocated collarbone affect your breathing? ›

Patients may die if the great vessels are ruptured by the end of the dislocated clavicle. Rupture may also cause breathing difficulties, dyspnea, a choking sensation, dysphagia, or a tight feeling in the throat (1, 2, 7).

Can a clavicle be out of place? ›

Clavicle fracture or broken collarbone may break in one place or several places (comminuted fracture). A displaced collarbone fracture happens when the ends of the broken bones don't line up. Dislocated shoulder occurs when the upper arm bone (humerus) pops out of the shoulder blade socket.

What causes sternoclavicular pain? ›

In summary. Sternoclavicular joint pain can arise due to the acute onset of a sporting injury, an impact (e.g. caused by a road traffic accident) or a rheumatological disorder. Due to the significant ligamentous stability of this joint, dislocations of the SCJ are rare.

What causes sternoclavicular joint swelling? ›

The sternoclavicular joint (SCJ) is an integral part of the shoulder girdle that connects the upper limb to the axial skeleton. Swelling of the SCJ is commonly due to trauma, degeneration, infections and other disease processes that affect synovial joints.

Can you dislocate your sternum? ›

If you dislocate your sternum, it usually become separated from the clavicle. However, ribs can separate from the sternum as well. In many cases, as the joint that connects the two bones separates, you'll hear a popping sound.

How common is sternoclavicular? ›

Sternoclavicular joint involvement has been reported in 1%–41% patients with rheumatoid arthritis, 2%–28% patients with ankylosing spondylitis, 15% patients with psoriatic arthritis, and rarely in reactive arthritis (9).

Can SC joint cause neck pain? ›

Studies have shown that your sternoclavicular joint can refer pain up into your neck and jaw, as well as along your collar bone towards your shoulder.

How many ligaments are in the sternoclavicular joint? ›

Most of the sternoclavicular joint's strength and stability originates from the surrounding joint capsule and is reinforced by four ligaments. The capsule surrounding the joint is weakest inferiorly, while it is reinforced on the superior, anterior and posterior aspects by the various ligaments.

What are the signs and symptoms of a sternoclavicular joint injury? ›

Symptoms will include pain when pressing in specifically at the sternoclavicular joint where the collarbone meets the sternum. Pain may radiate into the shoulder and it is likely there will be a visible bony lump over the joint.

What is the difference between a dislocation and a subluxation? ›

Dislocation is injury to a joint that causes adjoining bones to no longer touch each other. Subluxation is a minor or incomplete dislocation in which the joint surfaces still touch but are not in normal relation to each other.

Why is one clavicle bigger than the other? ›

“Clavicles are generally symmetrical, but asymmetry is not necessarily something to worry about,” says J. Mark Anderson, MD, DABFM, of Executive Medicine of Texas and who is board certified in family medicine. What is this? “Many people are born with one side more pronounced than the other,” continues Dr.

What happens if you leave a dislocated shoulder untreated? ›

Complications of a dislocated shoulder might include: Tearing of the muscles, ligaments and tendons that reinforce the shoulder joint. Nerve or blood vessel damage in or around the shoulder joint. Becoming more prone to repeat dislocations, especially if the injury is severe.

What happens if a broken collarbone goes untreated? ›

Delayed Union. When a bone fracture is untreated, it can result in either a nonunion or a delayed union. In the former case, the bone doesn't heal at all, which means that it will remain broken. As a result, swelling, tenderness, and pain will continue to worsen over time.

Can clavicle fracture heal itself? ›

Usually a broken collarbone will heal on its own. You just need to give it time. To help speed the healing, you might get: A splint or brace to keep your shoulder from moving.

Does a displaced clavicle fracture need surgery? ›

Clavicle fractures that are displaced or shifted significantly may require surgery. Additionally, clavicle fractures with interposed loose “butterfly” fragments or a “kickstand” piece may require surgery.

How do you know if you dislocated your collar bone? ›

If you are contending with a dislocation, the severe pain that you feel in the shoulder and upper arm will make you aware that you probably dealing with this condition. You could also observe swelling in your shoulder, or notice that your shoulder now contains a bump in either the front or back of the joint.

How do you tape a dislocated clavicle? ›

RockTape - Kinesiology Taping - Broken Collar Bone - YouTube

How do you tape a dislocated collarbone? ›

RockTape - Kinesiology Tape Instruction - Collar Bone - YouTube

Can you tape a broken collarbone? ›

Broken collarbone or clavicle fracture

Treatment with CureTape is a pleasant option for the patient. The first two ligament tapes are applied over the fracture. In addition it is also possible to apply a shoulder tape that has a calming effect on the deltoid muscle, thus supporting arm movement.

What's the most painful bone to break? ›

The Femur is often put at the top of the most painful bones to break. Your Femur is the longest and strongest bone in your body, running from your hip to your knee. Given its importance, it's not surprising that breaking this bone is an incredibly painful experience, especially with the constant weight being put on it.

How long does clavicle surgery take? ›

The surgery usually takes between 45-90 min. Usually, this operation is done as daycare surgery, where you go home the same day as the surgery. What to expect during healing of a Clavicle Fracture: While the bone heals usually within 2-3 months, recovery takes much longer.

How long is recovery from clavicle surgery? ›

You should also wait to play sports. In general, recovery is similar to treating a broken clavicle without surgery with return to normal activity around three months or so and full recovery up to six to 12 months after surgery.

Why does my sternoclavicular joint pop? ›

In moderate sprains, the joint becomes unstable. In rare cases, patients have a stable joint but a painful clicking, grating, or popping feeling. This indicates an injury to the intra-articular disc ligament. This type of injury causes pain and problems moving the SC joint.

What type of shoulder dislocation is the most common? ›

The shoulder joint is the most frequently dislocated joint of the body. Because it moves in several directions, your shoulder can dislocate forward, backward or downward. The most common variety is a forward (anterior) dislocation.

How do you know if you dislocated your collar bone? ›

If you are contending with a dislocation, the severe pain that you feel in the shoulder and upper arm will make you aware that you probably dealing with this condition. You could also observe swelling in your shoulder, or notice that your shoulder now contains a bump in either the front or back of the joint.

What happens when your collarbone pops out? ›

Collarbone popping can be caused by problems with any of them. Injury, lax ligaments, or hypermobile joints are also possible causes. Get medical attention for popping caused by trauma, infection, or inflammation, or if you can't move your shoulder.

What muscles helps to stabilize the sternoclavicular joint? ›

The costoclavicular ligament's orientation to the SC joint, anchoring the inferior surface of the sternal end of the clavicle to the first rib, serves as the primary restraint for the SC joint. The subclavius muscle also functions to provide joint stability.

How do you pop your clavicle back in place? ›

How to SELF Pop Your Collar Bone - YouTube

How do you tape a SC joint? ›

How to Apply PF Performance Tape - Collarbone - YouTube

What is the first aid treatment for dislocation? ›

Until you receive help, splint the affected joint into its fixed position. Don't try to move a dislocated joint or force it back into place. This can damage the joint and its surrounding muscles, ligaments, nerves or blood vessels. Put ice on the injured joint.

How long after shoulder dislocation can I lift? ›

You'll usually be able to resume most activities within 2 weeks, but should avoid heavy lifting and sports involving shoulder movements for between 6 weeks and 3 months. Your care team will advise you. You'll probably be off work for 2 to 4 weeks, or longer, if you have a physical job.

Which surgery is best for shoulder dislocation? ›

Arthroscopic Shoulder Surgery

Surgery for a dislocated shoulder is often required to tighten torn or stretched tendons or ligaments. A surgeon may also repair a torn labrum, the ring of cartilage that surrounds the shoulder socket and stabilizes the humerus. Together, these soft tissues hold the joint in place.

Can your collarbone pop out of place? ›

Because it's so thin and close to the skin, the collarbone is one of the most commonly fractured bones. It's second nature to put out your hand to stop a fall. But the force on your collarbone can cause a fracture or dislocation.

How long does a dislocated collarbone take to heal? ›

It usually happens after a fall or a blow to the shoulder. It takes about 6 to 8 weeks to heal in adults, and 3 to 6 weeks in children. The collarbone is a long, slender bone that runs from the breastbone to each shoulder.

What's the most painful bone to break? ›

The Femur is often put at the top of the most painful bones to break. Your Femur is the longest and strongest bone in your body, running from your hip to your knee. Given its importance, it's not surprising that breaking this bone is an incredibly painful experience, especially with the constant weight being put on it.

Does a dislocated clavicle hurt? ›

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.

What does a dislocated collarbone feel like? ›

Intense pain as soon as the injury occurs. Tenderness of the shoulder and collarbone. Swelling. Bruising.

How do you treat a swollen sternoclavicular joint? ›

Aspiration of the acutely swollen joint can diagnose gout or pseudogout. Both conditions can affect the sternoclavicular joint. Treatment consists of conservative measures such as non-steroidal anti-inflammatory agents and local injection of corticosteroids.

Videos

1. sternoclavicular joint dislocation
(medicinehu2010)
2. Posterior Dislocation Sternoclavicular Joint - Everything You Need To Know - Dr. Nabil Ebraheim
(nabil ebraheim)
3. SC dislocation: Mechanism of injury and treatment of a sternoclavicular dislocation
(Dr. David Geier)
4. Sternoclavicular Joint Reconstruction: Hamstring Autograft, Irreducible Anterior Dislocation
(NewYorkOrtho)
5. Sternoclavicular Joint
(Dani Moffit)
6. SC Joint Pain Prior to Stabilization
(shoulderspecialists)

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