Picture Case - Shoulder Pain

[Reasonable Rascal]

This young woman tripped down a flight of stairs and fell, landing on her left shoulder. She complains of localized pain and swelling over the sternoclavicular joint. Her extremities are neurovascularly intact. What tests should be performed? What is the diagnosis?

http://www.emedicine.com/shared/pub/cotw/0003.jpg

[Reasonable Rascal]

Anterior sternoclavicular joint dislocation:

Dislocation of the sternoclavicular joint is rare and primarily a clinical diagnosis. Anteroposterior and cephalic tilt radiography is indicated. The cephalic tilt view is obtained by tilting the x-ray beam 40° in the cephalic direction. However, CT scanning is becoming the preferred imaging modality for the evaluation of sternoclavicular injuries. In this patient, the radiographs showed an anterior subluxation but no fracture. Oral pain medication was given, a sling was applied, and an orthopedic surgeon was consulted to reduce the injury with the patient under conscious sedation. Acute posterior sternoclavicular joint dislocations are true orthopedic emergencies. The medial end of the clavicle becomes posteriorly displaced behind the sternum, placing pressure on the underlying trachea that can cause airway obstruction. The patient usually has severe pain and complains of pressure on his or her throat.


Contributed by
Kimberly Orlob, MD, and Heather Pyle, MD