Sternoclavicular joint (SCJ) dislocation is rare, accounting for only ~2% of joint dislocations and especially when compared to other traumatic upper limb injuries such as clavicular fractures.
Most cases result from indirect trauma 5, especially high-speed motor vehicle accidents. Spontaneous dislocations can also occur, these are typically anterior and occur in young men 2.
The injury can be broadly categorised into two types:
- anterior: two-to-three times more common, less serious
- posterior: potentially more serious because of the possibility of damage to mediastinal structures (e.g. great vessels, trachea, oesophagus, etc.) as a result of posterior displacement of the medial clavicle head. These injuries should prompt assessment of the mediastinal structures with CTA
- bilateral: easily missed on plain film imaging, a rare however necessary consideration, best demonstrated on crossectional imaging 7
SCJ dislocations are associated with the following injuries 3:
- anterior dislocation
- posterior dislocation
- joint space widening at the sternoclavicular joint
- more easily visualised on an angled view, on this view inferior displacement of the medial head of the clavicle is indicative of a posterior dislocation, whereas superior displacement of the clavicle indicates an anterior dislocation 6
- difficult to determine anterior or posterior dislocation
- joint space widening and asymmetry at the sternoclavicular joint
- associated injuries of the mediastinum
Treatment and prognosis
Options include conservative treatment, especially for anterior dislocation. Posterior dislocations are normally treated with closed reduction. Surgical fixation (ORIF) is usually reserved for unreduced posterior dislocations 2.
Thoracic outlet syndrome may occur as a late complication of posterior dislocation.
- 1. Macdonald PB, Lapointe P. Acromioclavicular and sternoclavicular joint injuries. Orthop. Clin. North Am. 2008;39 (4): 535-45, viii. doi:10.1016/j.ocl.2008.05.003 - Pubmed citation
- 2. Van Tongel A, De Wilde L. Sternoclavicular joint injuries: a literature review. Muscles Ligaments Tendons J. 2013;1 (3): 100-5. Free text at pubmed - Pubmed citation
- 3. Oikonomou A, Prassopoulos P. CT imaging of blunt chest trauma. Insights Imaging. 2011;2 (3): 281-295. doi:10.1007/s13244-011-0072-9 - Free text at pubmed - Pubmed citation
- 4. Nicholson DA, Lang I, Hughes P et-al. ABC of emergency radiology. The shoulder. BMJ. 1994;307 (6912): 1129-34. Free text at pubmed - Pubmed citation
- 5. Mirka H, Ferda J, Baxa J. Multidetector computed tomography of chest trauma: indications, technique and interpretation. Insights Imaging. 2012;3 (5): 433-49. doi:10.1007/s13244-012-0187-7 - Free text at pubmed - Pubmed citation
- 6. Morell DJ, Thyagarajan DS. Sternoclavicular joint dislocation and its management: A review of the literature. World journal of orthopedics. 7 (4): 244-50. doi:10.5312/wjo.v7.i4.244 - Pubmed
- 7. Saltzman MD, Mercer DM, Bertelsen A, Warme WJ, Matsen FA. Bilateral Posterior Sternoclavicular Dislocations. Radiology case reports. 4 (1): 256. doi:10.2484/rcr.v4i1.256 - Pubmed