My daughter just went in for surgery for a dislocated sternoclavicular joint. They weren't sure how severe it is because of the swelling. What can we expect with an injury like this?
The place where your collarbone meets the breast bone is called the sternoclavicular (SC) joint. Another name for the breast bone is the sternum. The anatomical term for the collarbone is clavicle, hence the name for the joint between these two bones: sternoclavicular or SC joint.
Injuries to the SC joint are rare but when they do occur, the results can be very serious. The close proximity of structures such as the trachea, esophagus, lungs, blood vessels, and nerves to the arms makes this injury the cause of problems that can be life-threatening.
Injuries of the SC joint can be classified as mild-to-severe. A mild injury means there's pain and even swelling but the ligaments aren't torn or damaged so the joint is still stable. If the ligaments stretch because of severe swelling, the joint can get partially separated, a condition called subluxation. Subluxation is considered a moderate injury. The most serious injury is a dislocation.
The swelling can prevent the surgeon from being able to tell the direction of the dislocation (anterior or posterior). The patient's symptoms are somewhat diagnostic. For example, difficulty breathing may point to a posterior dislocation affecting the trachea (windpipe) or lungs. Difficulty swallowing suggests injury to the esophagus.
Imaging studies such as X-rays, MRIs, and CT scans are usually needed to make the final diagnosis and help the surgeon plan the best course of treatment. Mild injuries may respond well to conservative (nonoperative) care. Ice and pain relievers relieve symptoms (pain and swelling) and positioning with a sling helps protect the area while it is healing.
There are two ways to reduce (realign) a SC joint that is dislocated: closed or open reduction. Anterior dislocations are treated most often with closed reduction. Closed means the surgeon does not make an incision to gain access to the joint. Instead with the patient asleep (under anesthesia), pressure is applied to the collarbone to push it back in place. The joint will probably still be unstable until healing is completed, so the joint is supported and protected for a few weeks.
Posterior dislocations of the SC joint can also be treated with closed reduction. Again, the patient must be sedated. The surgeon uses positioning and traction of the arm while an assistant applies pressure to the clavicle to shift it back in place. X-rays are taken to confirm successful closed reduction of anterior or posterior dislocations treated in this fashion.
When the surgical team is unable to use closed reduction, an open procedure is done. The clavicle is manually reduced and stability of the joint assessed. Reconstructive surgery using a tendon graft to replace the ruptured ligaments may be needed to restore joint stability. The surgeon may not know what will be needed until during the surgery -- whether reduction can be done with positioning and traction or with a surgical procedure. Expect her to be immobilized for a few weeks and make a nice recovery.
Gordon I. Groh, MD, and Michael A. Wirth, MD. Management of Traumatic Sternoclavicular Joint Injuries.
In Journal of the American Academy of Orthopaedic Surgeons. January 2011. Vol. 19. No. 1. Pp. 1-7.
*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.