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Sternoclavicular Joint Dislocation
The sternoclavicular (SC) joint is the pivot on which the shoulder girdle moves on the trunk. It is located at the junction of the collar bone and the breast bone. Dislocation of this joint most often results from a fall onto the shoulder.
The type of treatment your physician prescribes will depend entirely on the type of injury to your joint.
Anterior or forward dislocations are the most common and can sometimes occur with minimal trauma in patients with generalized looseness in their joints. Posterior dislocation of the sternoclavicular joint is less common than the anterior type but is potentially much more serious. Damage to important structures located behind the sternoclavicular joint (arteries, veins, nerves, esophagus, trachea) can cause difficulty breathing and swallowing, poor circulation to the arm and hand, and nerve damage.
Treatment
Most severe dislocations are of the anterior type and can be treated by pulling, pushing, and moving the clavicle until it pops back into joint. This procedure can be very painful and most patients will be given general anesthesia and perhaps muscle relaxants before the procedure. After the closed reduction is performed, the SC joint will have to be held perfectly still. The physician will most likely recommend the patient continue with pain medication while wearing a figure-eight strap for at least six weeks. With anterior dislocations, redisloction is common but is often not very painful and can be tolerated without surgery.
Posterior sternoclavicular dislocations should always be reduced in the operating room and are usually stable after reduction. They are also more likely to require an open (requiring a surgical incision) reduction than the anterior type. Postoperatively they are treated like their anterior counterpart but are more often stable over the long term.
In patients with chronic instability of the sternoclavicular joint, surgery may be indicated. In chronic posterior instability, potential for damage to important neurovascular structures is a good reason for surgical reduction and stabilization. For individuals with chronic anterior instability engaged in strenuous activities such as sports-aching, swelling, as well as rapid fatigue may result. In addition, the onset of age and osteoarthritic changes may cause permanent stiffness and aching and restrict the full range of normal movement of the shoulder. These symptoms comprise the rare indications for surgical intervention. |
