Case 36 - Sternoclavicular dislocation

Summary

Imaging description

On chest radiographs, a difference in the relative craniocaudal positions of the medial clavicles of greater than 50% of the width of the clavicular heads is suggestive of sternoclavicular joint (SCJ) dislocation (Figure 36.1) [1]. While a number of additional specific radiographic views including the serendipity (Rockwood) (Figure 36.2), Hobb, Kattan, and Heinig views have been proposed, CT is the best study to perform when SCJ dislocation is suspected. CT helps characterize dislocation as either anterior or posterior and is useful for assessing associated injuries [2]. If a posterior dislocation is suspected, we perform CT angiography of the mediastinum as part of the evaluation (Figure 36.3).

Sternoclavicular joint dislocations are rare injuries [3]. Less than 2–3% of all dislocations involving the pectoral girdle involve the sternoclavicular joint [4]. Anterior or presternal displacement is much more common than posterior displacement [5].

Importance

Although anterior dislocations have limited skeletal morbidity, they indicate high-energy trauma and more than two-thirds of anterior dislocations are associated with other serious injuries including pneumothorax, hemothorax, and pulmonary contusions [5].