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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