Traumatic Conditions (Dislocations): Sterno-Clavicular Disruption

The image shows a sterno-clavicular injury on patient’s right side.

Direct force to the front of the sterno-clavicular joint can cause a posterior dislocation, one of the few upper limb injuries that can cause an immediate threat to life. It can give rise to cough, hoarseness and even pneumothorax or tracheal compression. These dislocations are usually associated with severe pain. There may be venous congestion due to compression of the internal jugular vein, along with ipsilateral arm venous congestion. The medial end of the clavicle is usually easily palpated but with a posterior dislocation it has disappeared on the affected side.

How useful is a plain x-ray?

The sterno-clavicular joint is notoriously difficult to interpret on plain x-rays and, in cases of airway compromise, clinical assessment alone may be all that is required before treatment is attempted.

How could you treat this condition?

An attempt can be made at closed reduction. Traction is applied to the arm and it is sometimes possible to grasp the clavicle through the skin and pull it forwards, hopefully resulting in a ‘pop’ as reduction occurs.

Learning bite

In extremis the traditional method of bringing the clavicle away from the trachea is to grasp it with a towel clip through the skin and pull forwards.