Shoulder:Disorders of the Sternoclavicular Joint - Revision history

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Introduction

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Treatment (Management)

Alexandre.laedermann at 12:55, 26 May 2021

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Enhancing Healthcare Team Outcomes

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Enhancing Healthcare Team Outcomes

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Treatment (Management)

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 *Sternoclavicular injuries are rare due to the strong ligamentous support of the joint. A significant force is required to cause a dislocation although spontaneous subluxation can occur. In patients younger than 25, the provider also needs to consider medial clavicle physeal fracture.
 *Typically there is pain, swelling, and deformity at the joint. If the patient experiences these symptoms, they should be evaluated emergently.
-*Although radiographs can be helpful, the diagnosis is made with computed tomography (CT).
+*Although radiographs can be helpful, the diagnosis is made with computed tomography.
 *Most sternoclavicular joint injuries are managed nonoperatively, rest including a sling or figure-of-8 brace, physical therapy, and a graded return to activities of daily living. Posterior sternoclavicular joint dislocations are a surgical emergency requiring evaluation by an orthopedic surgeon due to the proximity of the great vessels and mediastinal structures.
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 ==Introduction==
-Sternoclavicular (SC) joint injuries are uncommon.
+Sternoclavicular joint injuries are uncommon.
 The sternoclavicular joint is a diarthrodial joint composed of the sternum and clavicle. It is stabilized by the posterior capsular ligament which provides the most anterior-posterior stability and the anterior sternoclavicular ligament which restricts superior displacement. The costoclavicular ligament helps provide medial clavicle and anterior first rib stability. The interclavicular ligament passes over the sternum to provide medial traction of both clavicles. The inter-articular disc ligament attaches to the first rib and also provides stability of the sternoclavicular joint. In between the two articular surfaces and within the joint space is a fibrocartilaginous articular disc which functions as an important shock absorber. It is the only synovial articulation between the upper limb and axial skeleton. The subclavius muscle also supports the integrity of the joint. There are vital anatomic structures behind the clavicle which include the innominate artery and vein, vagus nerve, phrenic nerve, internal jugular vein, trachea, and esophagus. The medial clavicle physis appears in late adolescence and does not ossify until the age of 25.
@@ Line 75: / Line 75: @@
 Radiographs are the initial imaging modality of choice in suspected sternoclavicular separations or dislocations. Anterior-posterior views may be helpful; lateral views are unlikely to be of significant utility to assess the joint due to superimposed structures. The serendipity view, obtained by tilting the beam 40 degrees cranial can help better assess the sternoclavicular joint. A Hobbs view may also be obtained. In anterior dislocations, the affected clavicle will be visualized above the contralateral clavicle; in posterior dislocations, the opposite is true.
-In suspected or radiograph-confirmed sternoclavicular dislocations, computed tomography (CT) scan is the imaging study of choice. This provides a multiplanar evaluation of the joint space with three-dimensional reconstruction. In posterior dislocations, computed tomography (CT) images can better visualize the mediastinal structures and co-occurring injuries. In children, it is also important to distinguish from a physeal fracture, which is better visualized on computed tomography (CT). Angiography should be utilized if the vascular injury is suspected.
+In suspected or radiograph-confirmed sternoclavicular dislocations, computed tomography scan is the imaging study of choice. This provides a multiplanar evaluation of the joint space with three-dimensional reconstruction. In posterior dislocations, computed tomography images can better visualize the mediastinal structures and co-occurring injuries. In children, it is also important to distinguish from a physeal fracture, which is better visualized on computed tomography. Angiography should be utilized if the vascular injury is suspected.
-Ultrasound can be used to identify posterior dislocations; however, it does not provide the same evaluation as computed tomography (CT) scan when available. MRI may have some utility in evaluating ligamentous injury but should be ordered at the discretion of one’s consultants.
+Ultrasound can be used to identify posterior dislocations; however, it does not provide the same evaluation as computed tomography scan when available. Magnetic resonance imaging may have some utility in evaluating ligamentous injury but should be ordered at the discretion of one’s consultants.
 ==Treatment (Management)==
@@ Line 95: / Line 95: @@
 ==Prognosis==
-The prognosis for sternoclavicular injuries is generally favorable. In sprains or grade I injuries, the ligamentous structures are intact, and patients will make a full recovery in 1 to 2 weeks. In grade II injuries in which there was a traumatic or spontaneous subluxation, recovery takes longer. There is a possibility of cosmetic sequelae but typically not functional sequelae.
+The prognosis for sternoclavicular injuries is generally favorable. In sprains or grade I injuries, the ligamentous structures are intact, and patients will make a full recovery in one to two weeks. In grade II injuries in which there was a traumatic or spontaneous subluxation, recovery takes longer. There is a possibility of cosmetic sequelae but typically not functional sequelae.
 Anterior dislocations generally do well. Management is controversial and should be done in conjunction with an orthopedic surgeon. Because posterior dislocations have a high rate of complication, they are a surgical emergency requiring orthopedic consultation and reduction. If there is any evidence of injury to the neurovascular or mediastinal structures, open reduction and internal fixation are indicated emergently. Many patients with posterior dislocations also have other injuries and may have residual chronic pain or limited range of motion, despite treatment.<ref>Sanchez G, Kennedy NI, Ferrari MB, Chang A, Provencher MT. Sternoclavicular Joint Reconstruction in the Setting of Medial Comminuted Clavicle Fracture. Arthrosc Tech. 2017;6:e1355-e1359</ref><ref>Choo AM, Schottel PC, Burgess AR. Scapulothoracic Dissociation: Evaluation and Management. J Am Acad Orthop Surg. 2017;25:339-347</ref>

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 Acute anterior dislocations of the sternoclavicular joint are controversial, primarily because it is a rare injury and difficult to study under controlled settings.<ref>de Jong KP, Sukul DM. Anterior sternoclavicular dislocation: a long-term follow-up study. J Orthop Trauma. 1990;4:420-3</ref> Because most anterior dislocations have a minimal long-term functional impact on quality of life, non-operative management is typically recommended, but the decision is made at the discretion of the orthopedic surgeon. Most surgeons recommend at least attempting closed reduction under general anesthesia, although residual instability of the joint space is commonpontaneous atraumatic anterior subluxation of the sternoclavicular joint.<ref>Rockwood CA, Odor JM. Spontaneous atraumatic anterior subluxation of the sternoclavicular joint. J Bone Joint Surg Am. 1989;71:1280-8</ref> In most cases, the risk of surgery outweighs the benefits.
-Posterior dislocations are a surgical emergency requiring consultation with an orthopedic surgeon.<ref>Sernandez H, Riehl J. Sternoclavicular Joint Dislocation: A Systematic Review and Meta-analysis. J Orthop Trauma. 2019;33:e251-e255</ref><ref>Hellwinkel JE, McCarty EC, Khodaee M. Sports-related sternoclavicular joint injuries. Phys Sportsmed. 2019;47(3):253-261</ref> Acute posterior dislocations less than 3 weeks old without evidence of mediastinal injury can be managed with closed reduction under general anesthesia. The standard technique is similar to anterior dislocations, where abduction and traction are used. If reduction is unstable or unsuccessful, the patient will have to decide whether to tolerate the deformity or an orthopedic surgeon can also perform an osteotomy of the medial clavicle.
+Posterior dislocations are a surgical emergency requiring consultation with an orthopedic surgeon.<ref>Sernandez H, Riehl J. Sternoclavicular Joint Dislocation: A Systematic Review and Meta-analysis. J Orthop Trauma. 2019;33:e251-e255</ref><ref>Hellwinkel JE, McCarty EC, Khodaee M. Sports-related sternoclavicular joint injuries. Phys Sportsmed. 2019;47(3):253-261</ref> Acute posterior dislocations less than 3 weeks old without evidence of mediastinal injury can be managed with closed reduction under general anesthesia (Video). The standard technique is similar to anterior dislocations, where abduction and traction are used. If reduction is unstable or unsuccessful, the patient will have to decide whether to tolerate the deformity or an orthopedic surgeon can also perform an osteotomy of the medial clavicle.
 Acute posterior dislocations with any evidence of vascular injuries, including decreased peripheral pulses, mediastinal injuries such as dysphagia, or pulmonary injuries such as shortness of breath need emergent open reduction and internal fixation with thoracic or vascular surgeons on stand-by.<ref>Ono K, Inagawa H, Kiyota K, Terada T, Suzuki S, Maekawa K. Posterior dislocation of the sternoclavicular joint with obstruction of the innominate vein: case report. J Trauma. 1998;44:381-3</ref> It is also worth noting case reports of complications arising from unreduced posterior dislocations without any initial evidence of mediastinal injury. Thus, it can be argued that a failed closed reduction of posterior dislocation is an indication for open reduction and internal fixation.

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 ==Pathophysiology==
-A sternoclavicular joint injury is a rare injury to the shoulder girdle.<ref>Robinson CM, Jenkins PJ, Markham PE, Beggs I. Disorders of the sternoclavicular joint. J Bone Joint Surg Br. 2008;90(6):685-96</ref> This is because the more peripherally placed bones and joints of the shoulder girdle tend to receive more of the energy from blunt trauma. The relatively strong, well reinforced sternoclavicular joint requires a substantial force of a specific vector to disrupt the joint space. Mechanisms significant to produce such a force include fall from height, contact and collision sports, and motor vehicle accidents.
+A sternoclavicular joint injury is a rare injury to the shoulder girdle.<ref>Robinson CM, Jenkins PJ, Markham PE, Beggs I. Disorders of the sternoclavicular joint. J Bone Joint Surg Br. 2008;90;685-96</ref> This is because the more peripherally placed bones and joints of the shoulder girdle tend to receive more of the energy from blunt trauma. The relatively strong, well reinforced sternoclavicular joint requires a substantial force of a specific vector to disrupt the joint space. Mechanisms significant to produce such a force include fall from height, contact and collision sports, and motor vehicle accidents.
 Trauma may be directed at the medial clavicle or more commonly from an indirect blow to the shoulder. The mechanism typically determines the type of sternoclavicular dislocation. In anterior dislocations, the force is typically directed anterolaterally at the shoulder pushing the shoulder back and forcing the clavicle anteriorly on the medial side. Conversely, a posterolateral vector will push the shoulder anteriorly leading to a posterior clavicle dislocation. Although less common, a posterior clavicle dislocation can also occur from direct trauma to the medial clavicle.
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 ==Treatment (Management)==
-Atraumatic subluxations and chronic anterior dislocations can be managed nonoperatively with reassurance.<ref>Macdonald PB, Lapointe P. Acromioclavicular and sternoclavicular joint injuries. Orthop. Clin. North Am. 2008;39(4):535-45</ref> Generally, this includes a sling for comfort, which can be weaned, physical therapy, analgesia, and a graded return to play and activity. Grade I sprains can resolve in one to two weeks.<ref>Yeh GL, Williams GR. Conservative management of sternoclavicular injuries. Orthop. Clin. North Am. 2000;31(2):189-203</ref> Grade II sprains can be managed conservatively as well; however, due to partial tearing of ligamentous structures, management requires a greater course of immobilization and protection. These patients may require a figure-of-eight brace as well.
+Atraumatic subluxations and chronic anterior dislocations can be managed nonoperatively with reassurance.<ref>Macdonald PB, Lapointe P. Acromioclavicular and sternoclavicular joint injuries. Orthop. Clin. North Am. 2008;39:535-45</ref> Generally, this includes a sling for comfort, which can be weaned, physical therapy, analgesia, and a graded return to play and activity. Grade I sprains can resolve in one to two weeks.<ref>Yeh GL, Williams GR. Conservative management of sternoclavicular injuries. Orthop. Clin. North Am. 2000;31:189-203</ref> Grade II sprains can be managed conservatively as well; however, due to partial tearing of ligamentous structures, management requires a greater course of immobilization and protection. These patients may require a figure-of-eight brace as well.
-Acute anterior dislocations of the sternoclavicular joint are controversial, primarily because it is a rare injury and difficult to study under controlled settings.<ref>de Jong KP, Sukul DM. Anterior sternoclavicular dislocation: a long-term follow-up study. J Orthop Trauma. 1990;4(4):420-3</ref> Because most anterior dislocations have a minimal long-term functional impact on quality of life, non-operative management is typically recommended, but the decision is made at the discretion of the orthopedic surgeon. Most surgeons recommend at least attempting closed reduction under general anesthesia, although residual instability of the joint space is commonpontaneous atraumatic anterior subluxation of the sternoclavicular joint.<ref>Rockwood CA, Odor JM. Spontaneous atraumatic anterior subluxation of the sternoclavicular joint. J Bone Joint Surg Am. 1989;71(9):1280-8</ref> In most cases, the risk of surgery outweighs the benefits.
+Acute anterior dislocations of the sternoclavicular joint are controversial, primarily because it is a rare injury and difficult to study under controlled settings.<ref>de Jong KP, Sukul DM. Anterior sternoclavicular dislocation: a long-term follow-up study. J Orthop Trauma. 1990;4:420-3</ref> Because most anterior dislocations have a minimal long-term functional impact on quality of life, non-operative management is typically recommended, but the decision is made at the discretion of the orthopedic surgeon. Most surgeons recommend at least attempting closed reduction under general anesthesia, although residual instability of the joint space is commonpontaneous atraumatic anterior subluxation of the sternoclavicular joint.<ref>Rockwood CA, Odor JM. Spontaneous atraumatic anterior subluxation of the sternoclavicular joint. J Bone Joint Surg Am. 1989;71:1280-8</ref> In most cases, the risk of surgery outweighs the benefits.
-Posterior dislocations are a surgical emergency requiring consultation with an orthopedic surgeon.<ref>Sernandez H, Riehl J. Sternoclavicular Joint Dislocation: A Systematic Review and Meta-analysis. J Orthop Trauma. 2019;33(7):e251-e255</ref><ref>Hellwinkel JE, McCarty EC, Khodaee M. Sports-related sternoclavicular joint injuries. Phys Sportsmed. 2019;47(3):253-261</ref> Acute posterior dislocations less than 3 weeks old without evidence of mediastinal injury can be managed with closed reduction under general anesthesia. The standard technique is similar to anterior dislocations, where abduction and traction are used. If reduction is unstable or unsuccessful, the patient will have to decide whether to tolerate the deformity or an orthopedic surgeon can also perform an osteotomy of the medial clavicle.
+Posterior dislocations are a surgical emergency requiring consultation with an orthopedic surgeon.<ref>Sernandez H, Riehl J. Sternoclavicular Joint Dislocation: A Systematic Review and Meta-analysis. J Orthop Trauma. 2019;33:e251-e255</ref><ref>Hellwinkel JE, McCarty EC, Khodaee M. Sports-related sternoclavicular joint injuries. Phys Sportsmed. 2019;47(3):253-261</ref> Acute posterior dislocations less than 3 weeks old without evidence of mediastinal injury can be managed with closed reduction under general anesthesia. The standard technique is similar to anterior dislocations, where abduction and traction are used. If reduction is unstable or unsuccessful, the patient will have to decide whether to tolerate the deformity or an orthopedic surgeon can also perform an osteotomy of the medial clavicle.
-Acute posterior dislocations with any evidence of vascular injuries, including decreased peripheral pulses, mediastinal injuries such as dysphagia, or pulmonary injuries such as shortness of breath need emergent open reduction and internal fixation with thoracic or vascular surgeons on stand-by.<ref>Ono K, Inagawa H, Kiyota K, Terada T, Suzuki S, Maekawa K. Posterior dislocation of the sternoclavicular joint with obstruction of the innominate vein: case report. J Trauma. 1998;44(2):381-3</ref> It is also worth noting case reports of complications arising from unreduced posterior dislocations without any initial evidence of mediastinal injury. Thus, it can be argued that a failed closed reduction of posterior dislocation is an indication for open reduction and internal fixation.
+Acute posterior dislocations with any evidence of vascular injuries, including decreased peripheral pulses, mediastinal injuries such as dysphagia, or pulmonary injuries such as shortness of breath need emergent open reduction and internal fixation with thoracic or vascular surgeons on stand-by.<ref>Ono K, Inagawa H, Kiyota K, Terada T, Suzuki S, Maekawa K. Posterior dislocation of the sternoclavicular joint with obstruction of the innominate vein: case report. J Trauma. 1998;44:381-3</ref> It is also worth noting case reports of complications arising from unreduced posterior dislocations without any initial evidence of mediastinal injury. Thus, it can be argued that a failed closed reduction of posterior dislocation is an indication for open reduction and internal fixation.
 Chronic or recurrent dislocations, anterior or posterior, as well as chronic pain at the sternoclavicular joint, are candidates for medical clavicle osteotomy.
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 The prognosis for sternoclavicular injuries is generally favorable. In sprains or grade I injuries, the ligamentous structures are intact, and patients will make a full recovery in 1 to 2 weeks. In grade II injuries in which there was a traumatic or spontaneous subluxation, recovery takes longer. There is a possibility of cosmetic sequelae but typically not functional sequelae.
-Anterior dislocations generally do well. Management is controversial and should be done in conjunction with an orthopedic surgeon. Because posterior dislocations have a high rate of complication, they are a surgical emergency requiring orthopedic consultation and reduction. If there is any evidence of injury to the neurovascular or mediastinal structures, open reduction and internal fixation are indicated emergently. Many patients with posterior dislocations also have other injuries and may have residual chronic pain or limited range of motion, despite treatment.<ref>Sanchez G, Kennedy NI, Ferrari MB, Chang A, Provencher MT. Sternoclavicular Joint Reconstruction in the Setting of Medial Comminuted Clavicle Fracture. Arthrosc Tech. 2017;6(4):e1355-e1359</ref><ref>Choo AM, Schottel PC, Burgess AR. Scapulothoracic Dissociation: Evaluation and Management. J Am Acad Orthop Surg. 2017;25(5):339-347</ref>
+Anterior dislocations generally do well. Management is controversial and should be done in conjunction with an orthopedic surgeon. Because posterior dislocations have a high rate of complication, they are a surgical emergency requiring orthopedic consultation and reduction. If there is any evidence of injury to the neurovascular or mediastinal structures, open reduction and internal fixation are indicated emergently. Many patients with posterior dislocations also have other injuries and may have residual chronic pain or limited range of motion, despite treatment.<ref>Sanchez G, Kennedy NI, Ferrari MB, Chang A, Provencher MT. Sternoclavicular Joint Reconstruction in the Setting of Medial Comminuted Clavicle Fracture. Arthrosc Tech. 2017;6:e1355-e1359</ref><ref>Choo AM, Schottel PC, Burgess AR. Scapulothoracic Dissociation: Evaluation and Management. J Am Acad Orthop Surg. 2017;25:339-347</ref>
 ==Complications==

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 *Most sternoclavicular joint injuries are managed nonoperatively, rest including a sling or figure-of-8 brace, physical therapy, and a graded return to activities of daily living. Posterior sternoclavicular joint dislocations are a surgical emergency requiring evaluation by an orthopedic surgeon due to the proximity of the great vessels and mediastinal structures.
-== Key words[edit | edit source] ==
+==Key words[edit | edit source]==
 This subsection does not exist. You can ask for it to be created, but consider checking the search results below to see whether the topic is already covered.<br />
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 ==Differential Diagnosis==
-The differential diagnosis of traumatic sternoclavicular injury is broad and includes fracture (sternum, clavicle, rib),  sternoclavicular sprain, subluxation, or dislocation (anterior, posterior). Non-traumatic causes of sternoclavicular pain include arthropathies (osteoarthritis, rheumatoid, seronegative, crystal), infection (septic arthritis or osteomyelitis), SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome, condensing osteitis, Friedrich disease, and multidirectional instability.
+The differential diagnosis of traumatic sternoclavicular injury is broad and includes fracture (sternum, clavicle, rib), sternoclavicular sprain, subluxation, or dislocation (anterior, posterior). Non-traumatic causes of sternoclavicular pain include arthropathies (osteoarthritis, rheumatoid, seronegative, crystal), infection (septic arthritis or osteomyelitis), SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome, condensing osteitis, Friedrich disease, and multidirectional instability.
 ==Prognosis==
 The prognosis for sternoclavicular injuries is generally favorable. In sprains or grade I injuries, the ligamentous structures are intact, and patients will make a full recovery in 1 to 2 weeks. In grade II injuries in which there was a traumatic or spontaneous subluxation, recovery takes longer. There is a possibility of cosmetic sequelae but typically not functional sequelae.
-Anterior dislocations generally do well. Management is controversial and should be done in conjunction with an orthopedic surgeon. Because posterior dislocations have a high rate of complication, they are a surgical emergency requiring orthopedic consultation and reduction. If there is any evidence of injury to the neurovascular or mediastinal structures, open reduction and internal fixation are indicated emergently. Many patients with posterior dislocations also have other injuries and may have residual chronic pain or limited ranage of motion, despite treatment.<ref>Sanchez G, Kennedy NI, Ferrari MB, Chang A, Provencher MT. Sternoclavicular Joint Reconstruction in the Setting of Medial Comminuted Clavicle Fracture. Arthrosc Tech. 2017;6(4):e1355-e1359</ref><ref>Choo AM, Schottel PC, Burgess AR. Scapulothoracic Dissociation: Evaluation and Management. J Am Acad Orthop Surg. 2017;25(5):339-347</ref>
+Anterior dislocations generally do well. Management is controversial and should be done in conjunction with an orthopedic surgeon. Because posterior dislocations have a high rate of complication, they are a surgical emergency requiring orthopedic consultation and reduction. If there is any evidence of injury to the neurovascular or mediastinal structures, open reduction and internal fixation are indicated emergently. Many patients with posterior dislocations also have other injuries and may have residual chronic pain or limited range of motion, despite treatment.<ref>Sanchez G, Kennedy NI, Ferrari MB, Chang A, Provencher MT. Sternoclavicular Joint Reconstruction in the Setting of Medial Comminuted Clavicle Fracture. Arthrosc Tech. 2017;6(4):e1355-e1359</ref><ref>Choo AM, Schottel PC, Burgess AR. Scapulothoracic Dissociation: Evaluation and Management. J Am Acad Orthop Surg. 2017;25(5):339-347</ref>
 ==Complications==

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 *Although radiographs can be helpful, the diagnosis is made with computed tomography (CT).
 *Most sternoclavicular joint injuries are managed nonoperatively, rest including a sling or figure-of-8 brace, physical therapy, and a graded return to activities of daily living. Posterior sternoclavicular joint dislocations are a surgical emergency requiring evaluation by an orthopedic surgeon due to the proximity of the great vessels and mediastinal structures.
 == Key words[edit | edit source] ==
-<br />
+This subsection does not exist. You can ask for it to be created, but consider checking the search results below to see whether the topic is already covered.<br />
-== History[edit | edit source] ==
+==History[edit | edit source]==
-<br />
+This subsection does not exist. You can ask for it to be created, but consider checking the search results below to see whether the topic is already covered.<br />
-== Anecdote[edit | edit source] ==
+==Anecdote[edit | edit source]==
-<br />
+This subsection does not exist. You can ask for it to be created, but consider checking the search results below to see whether the topic is already covered.<br />
-== Anatomical Considerations ==
+==Anatomical Considerations==
 ==Introduction==

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 From <ref>Kiel J, Kaiser K. Sternoclavicular Joint Injury. [Updated 2020 Jan 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan</ref>, with permission.
-== Bullet Points ==
+==Bullet Points==
-* Although spontaneous subluxations can occur, most are caused by high trauma such as a motor vehicle accident or collision in sports.
+*Although spontaneous subluxations can occur, most are caused by high trauma such as a motor vehicle accident or collision in sports.
-* Sternoclavicular injuries are rare due to the strong ligamentous support of the joint. A significant force is required to cause a dislocation although spontaneous subluxation can occur. In patients younger than 25, the provider also needs to consider medial clavicle physeal fracture.
+*Sternoclavicular injuries are rare due to the strong ligamentous support of the joint. A significant force is required to cause a dislocation although spontaneous subluxation can occur. In patients younger than 25, the provider also needs to consider medial clavicle physeal fracture.
-* Typically there is pain, swelling, and deformity at the joint. If the patient experiences these symptoms, they should be evaluated emergently.
+*Typically there is pain, swelling, and deformity at the joint. If the patient experiences these symptoms, they should be evaluated emergently.
-* Although radiographs can be helpful, the diagnosis is made with computed tomography (CT).
+*Although radiographs can be helpful, the diagnosis is made with computed tomography (CT).
-* Most sternoclavicular joint injuries are managed nonoperatively, rest including a sling or figure-of-8 brace, physical therapy, and a graded return to activities of daily living. Posterior sternoclavicular joint dislocations are a surgical emergency requiring evaluation by an orthopedic surgeon due to the proximity of the great vessels and mediastinal structures.
+*Most sternoclavicular joint injuries are managed nonoperatively, rest including a sling or figure-of-8 brace, physical therapy, and a graded return to activities of daily living. Posterior sternoclavicular joint dislocations are a surgical emergency requiring evaluation by an orthopedic surgeon due to the proximity of the great vessels and mediastinal structures.
 ==Introduction==
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 After closed reduction of acute anterior dislocations, the patient is immobilized in a sling. Depending on the stability of the joint, the patient is weaned out earlier (stable) or later (unstable) with progressive elbow and glenohumeral range of motion exercises. After closed reduction of acute posterior dislocations, the patient is immobilized in a figure-of-8 strap for at least 6 weeks. Active strengthening and range of motion exercises can begin around 12 weeks.
-== References ==
+==References==
 <references />

← Older revision		Revision as of 08:27, 19 July 2020
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	The outlook for most anterior dislocations are good but posterior dislocations have a guarded prognosis. Many patients with posterior dislocations also have other injuries and may have residual chronic pain or limited ranage of motion, despite treatment.<ref>Sanchez G, Kennedy NI, Ferrari MB, Chang A, Provencher MT. Sternoclavicular Joint Reconstruction in the Setting of Medial Comminuted Clavicle Fracture. Arthrosc Tech. 2017;6(4):e1355-e1359</ref><ref>Choo AM, Schottel PC, Burgess AR. Scapulothoracic Dissociation: Evaluation and Management. J Am Acad Orthop Surg. 2017;25(5):339-347</ref>		The outlook for most anterior dislocations are good but posterior dislocations have a guarded prognosis. Many patients with posterior dislocations also have other injuries and may have residual chronic pain or limited ranage of motion, despite treatment.<ref>Sanchez G, Kennedy NI, Ferrari MB, Chang A, Provencher MT. Sternoclavicular Joint Reconstruction in the Setting of Medial Comminuted Clavicle Fracture. Arthrosc Tech. 2017;6(4):e1355-e1359</ref><ref>Choo AM, Schottel PC, Burgess AR. Scapulothoracic Dissociation: Evaluation and Management. J Am Acad Orthop Surg. 2017;25(5):339-347</ref>
		+
		+	== References ==

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 == Enhancing Healthcare Team Outcomes ==
-The majority of patients with sternoclavicular injury present to the emergency room, the primary care provider or nurse practitioner. The majority of the mild injuries are managed without consulting a sports medicine physician or orthopedic surgeon. If there is any concern about dislocation, the patient should be evaluated in the emergency department. Acute anterior dislocations may be a candidate for closed reduction at the discretion of the orthopedic surgeons. Posterior dislocations are a surgical emergency requiring consultation with an orthopedic surgeon.[7][8]
+The majority of patients with sternoclavicular injury present to the emergency room, the primary care provider or nurse practitioner. The majority of the mild injuries are managed without consulting a sports medicine physician or orthopedic surgeon. If there is any concern about dislocation, the patient should be evaluated in the emergency department. Acute anterior dislocations may be a candidate for closed reduction at the discretion of the orthopedic surgeons. Posterior dislocations are a surgical emergency requiring consultation with an orthopedic surgeon.<ref>Sernandez H, Riehl J. Sternoclavicular Joint Dislocation: A Systematic Review and Meta-analysis. J Orthop Trauma. 2019;33(7):e251-e255</ref><ref>Hellwinkel JE, McCarty EC, Khodaee M. Sports-related sternoclavicular joint injuries. Phys Sportsmed. 2019;47(3):253-261</ref>
-The outlook for most anterior dislocations are good but posterior dislocations have a guarded prognosis. Many patients with posterior dislocations also have other injuries and may have residual chronic pain or limited ranage of motion, despite treatment.[9][10] (Level V)
+The outlook for most anterior dislocations are good but posterior dislocations have a guarded prognosis. Many patients with posterior dislocations also have other injuries and may have residual chronic pain or limited ranage of motion, despite treatment.<ref>Sanchez G, Kennedy NI, Ferrari MB, Chang A, Provencher MT. Sternoclavicular Joint Reconstruction in the Setting of Medial Comminuted Clavicle Fracture. Arthrosc Tech. 2017;6(4):e1355-e1359</ref><ref>Choo AM, Schottel PC, Burgess AR. Scapulothoracic Dissociation: Evaluation and Management. J Am Acad Orthop Surg. 2017;25(5):339-347</ref>