Presentation
MVA. Right shoulder pain.
Patient Data
Supine projection.
The lungs and pleural spaces are clear. No evidence of pneumothorax. Cardiomediastinal contours are normal for projection. Asymmetric widening of the right sternoclavicular joint is suspicious for a dislocation. No rib fracture identified.
Reduced lung volumes with dependent atelectasis. No evidence of a pulmonary contusion or laceration. Tiny right apical pneumothorax. Trace right pleural effusion.
Normal heart and pericardium. No evidence of vascular injury.
Non-displaced fracture through the head of the right first rib. No acute fracture of the clavicles, scapulae, or sternum. Right sternoclavicular joint anterosuperior dislocation. Possible subluxation of the first costochondral joint, given the intra-articular gas. Small volume of surrounding subcutaneous emphysema.
Case Discussion
Anterior dislocation of the sternoclavicular joint (SCJ) is more common than posterior dislocation and has less risk of mediastinal vascular injury. Injury to the SCJ is associated, not unsurprisingly, with other upper chest injuries such as pneumothorax, hemothorax, upper rib fracture, injuries to the brachial plexus and vascular injuries.