Clavicle dislocation#

Thu, 12 Jun 2008 00:05:44 +0000

In summer 2008 I managed to spring my clavicle out of the socket at the wrong end (anterior sterno-clavicular dislocation). Here are some notes I made at the time

I spent $20 on a 24 hour pass for access to papers from Elsevier (greedy bunch of people though they are) and clicked on everything that looked relevant. I shall summarise for posterity. Please note I am not a medical professional. I am even less of a medical professional than I am a coach or instructor, and as I've said elsewhere, I score 0% on the coachometer. Anything you read below is merely my supposition and should not be construed as medical advice.

First off: because it's quite a rare kind of dislocation, there doesn't seem to be complete consensus in how to treat it. Bear that in mind in what follows. Mostly I'm going by "Treatment and results of sternoclavicular joint injuries" by James Bicos and Gregory P. Nicholson, because it's the primary reference on whatever NHS practice guideline site it was I found.

The relevant mechanical details are as follows: although the joint is not an especially good fit in bone-on-bone terms, there are strong ligaments holding it together. Most are behind the joint (posterior), one is in front (anterior).

Dislocations may be anterior (clavicle ends up in front of the breast bone) or posterior aka retro-sternal (clavicle ends up behind the breastbone). The latter kind are really rather dangerous because of all the other important parts in that area (the "great vessels and other significant structures of the superior mediastinum") and generally need immediate expert attention, but also much less likely because of the better ligamentous support behind the bone.

Anterior dislocations are not dangerous in the same way, as all the wiring and plumbing is behind not in front. However, for this reason, most surgeons are reluctant to perform operative treatment to fix an anterior dislocation. A "closed reduction" - that is, manipulation of the shoulder to put the bone back in (usually involves a general anaesthetic) is possible (and recommended, insofar as there's any common opinion on this matter). However, the joint is also likely to remain unstable even if the dislocation is successfully reduced - i.e. it will dislocate again easily. There are even reports of people with completely spontaneous dislocations due to having loose ligaments. That said, "dislocations have little long term functional impact [...] because the upper extremity is still stabilized by the strong muscle insertions of the trapezius, sternocleidomastoid, and pectoralis major muscles" - so the only real downside to this "benign neglect" approach is cosmetic (lump on the chest). In some cases, the clavicle end binds ("adhesions" is the word here) to the sternum in its new position, but that doesn't seem to make much odds either way.

(In my case, the doctor seems to have decided not to attempt the recommended reduction presumably on the grounds that it probably won't stay fixed anyway. Given all the other bruising and muscle strains around that part of my body I'm not completely unsympathetic to his not making the effort)

Some sources say the joint should be strapped to immobilise it (if doing a closed reduction, apparently it should be strapped for six weeks). Doing this effectively is actually very difficult because the clavicle has a great long lever arm, which might be another reason not to reduce in the first place. The hospital gave me a collar and cuff, but more for the comfort than for any therapeutic value.

How long will it take? I still don't know, and couldn't find anything useful about rehabilitating it even in the Elsevier walled garden. Doctor said 6 months for "completely normal", but since I've never really been completely normal anyway, obviously what I really want to know is (a) when I can skate again, (b) when I can skate again with armswing, and (c) when I can put t-shirts on without pain (though that may be the other injuries not the dislocation anyway). So far it's been 12 days, which is not long enough to answer any of those questions from experience. My next followup appointment is in five weeks time. I'm speculating that when I get full movement back, strengthening the trapezius, sternocleidomastoid, and pectoralis major muscles will be a good thing to work on, but I really want to have that confirmed by someone who knows about this stuff before I hit the gym. Not that I'm in any immediate rush ...

Note that for people under 25, diagnoses of clavicle dislocation are often wrong: part of the clavicle called the physis (which is cartilage) does not turn into bone until about 20-25, and injuries to the physis may look like an SC joint dislocation.