Post on 27-Mar-2021
The Sternoclavicular
Joint
TimothyP.LeddyMDOrthopaedicSurgeon
HandandUpperExtremitySurgery
ClinicalAssistantInstructorofOrthopaedicSurgeryRutgers
No Disclosures
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The Sternoclavicular Joint
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Sternoclavicular injury in sports
• WhatimpactdoesSCinjuryhaveonathleAcfuncAon?
• WhatistheopAmaltreatmentforathleteswithSCinjuryinordertoreturntosporAngacAvity?
• MotorvehicleaccidentsandathleAcinjuriesaccountfor>80%ofinjuriestothisjoint.
– NeKlesJL,LinscheidRL:SternoclaviculardislocaAons.JTrauma1968;8(2):158-164.
• <3%ofallTraumaAcjointinjuries– Groh,JournaloftheAmericanAcademyofOrthopaedicSurgeons2011
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Function
• SCJointAestheshouldertothebodyanddissipatesrotaAonalforces.
• UnappreciatedinjurywillimpactshoulderfuncAon
• ProperimaginghelpstoidenAfyinjury
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Osteology
DiarthrodialorsaddlejointIncongruous(~50%contact)FibrocarAlage
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Diagnosis
• Symptoms:• anteriordislocaAon
– deformitywithpalpablebump• posteriordislocaAons
– dyspneaordysphagia– tachypneaandstridor
• DecreasedarmROM• Paresthesia• Turningheadtoaffectedsidemayrelievepain
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Mechanism of Injury
• Usuallyhighenergyinjury(MVA,contactsports)
• AtraumaAcSubluxaAonusuallyresultofligamentouslaxity
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Stability
• TheSCcapsularligamentsprovidestrongsupportandareassistedby:
• Thecostoclavicular(rhomboid)• Theintra-arAculardiscandligament• Theinterclavicularligaments
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What does it do?
• FuncAonstosupporttheweightoftheupperextremity
• ActsasatransiAonpointbetweentheshouldergirdleandthetrunk
• ProvidesprotecAonfortheunderlyingmediasAnalstructures.
www.UOANJ.com Balciketal2013
Imaging
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• Radiographs – AP and serendipity views
Beam at 40 cephalic tilt • anterior dislocation
• affected clavicle above contralateral clavicle • posterior dislocation
• affected clavicle below contralateral clavicle
– CT scan • Visualize mediastinal structures and injuries • can differentiate from physeal fractures
Studies of SC injury
• LargeprospecAvestudiesnotpossiblewiththefrequencyoftheinjury.
• Thisleavestheliteraturewithamyriadofcasereportsandmetaanalysis.
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Etiology of Pain
• Trauma• Sprain• SubluxaAon(Laxity)• DislocaAon
– Anterior– Posterior
• GrowthPlateInjury20-25• Fracture
• DegeneraAveanteriorsubluxaAon• NOTtobeconfusedwithtumor!Rare.
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Incidence
• ALLpaAentstotheERtothreelargehospitalsinBelgiumwithSCpainover2.5years.
• AtTotalof44paAentsidenAfied.• DegeneraAvearthriAswasthemostcommon.• AcuteTrauma• Tumorleastcommon
www.UOANJ.com VanTongeletal.BMCMusculoskeletalDisorders2014,15:421
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Posterior Dislocation
www.UOANJ.com M.Cruz,PTTheInterna:onalJournalofSportsPhysicalTherapy2015
Treatment
• Non-operaAve• DegeneraAvesubluxaAonanddislocaAon• AtraumaAcSubluxaAons
– Reassurance– Slingforcomfort
• OperaAve• PosteriordislocaAons
– ClosedvsOpenReducAon• ChronicInstability
– LigamentreconstrucAon– MedialClavicleExcision
www.UOANJ.com Rockwood,Green,andWilkins'FracturesinAdultsandChildrenPackage2014
Ligament Reconstruction
www.UOANJ.com SpencerEEJr,KuhnJE:BiomechanicalanalysisofreconstrucAonsforsternoclavicularjointinstability.JBoneJointSurgAm2004;86[1]:98–105.)
Ligament Reconstruction
• Rehab:– figure-of-8claviclesplintisusedfor4weeks– slingisusedforanaddiAonal6to8weeks– Noarmelevate≥60°– At12weeksgradualincreaseforacAviAesofdailyliving
– NoheavylaboracAviAeswhentheyhaveundergonemedialclavicleresecAon.
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Summary
• InjurytoSCJointisUncommon• ManagementisusuallyconservaAve• NeedstobeahighlevelofclinicalsuspicionforposteriordislocaAons
• RTSusuallybasedonfuncAonalrecoveryunlesssurgery
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