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Primary Surgery Vol.2 – Trauma : The shoulder and upper arm : Dislocations of the sterno–clavicular joint

71.5 Dislocations of the sterno–clavicular joint

The clavicle can dislocate anteriorly or posteriorly.

An anterior dislocation makes a patient’s sterno–cla­vi­cu­lar joint swollen and tender. This distinguishes it from a fracture of the medial end of his clavicle, where tenderness is immediately lateral to the joint. Reduction is usually unnecessary, so encourage him to use his arm (71.1). It will be weak for some months, but movement will in time become full and painless.

A posterior dislocation is rare and is usually combined with a chest injury, in which several of the patient’s ribs may be broken at the same time. The dislocated end of his clavicle obstructs his superior mediastinum and causes severe pain, a tight feeling in his throat, difficult swallowing, and fullness of the veins of his neck.

Try closed reduction first. Place a sandbag between his scapulae, and press his shoulders back. If this fails, refer him.

Previous: Fractures of the clavicle Up: The shoulder and upper arm Next: Dislocation of the acromio–clavicular joint Primary Surgery Vol.2 – Trauma