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The Sternoclavicular Joint
- 1. The Sternoclavicular Joint(SCJ) Great White Shark, Port Lincoln, 2016
- 2. Declaration of Interest Ideclare that in the past three years: • held shares in : Nil • received royalties from: Nil • done consulting work for: Nil • given paid presentation for: Nil • received institutional support from: Nil • Signed: Ash Moaveni
- 3. SC Joint Anatomy Instabilityand Degenerative Arthritis of the SCJ. AJSM 2014 • Only true articulation between the upper extremity and axial skeleton • Incongruent joint, relying on soft tissue for its stability
- 4. SC Joint Anatomy •Medial epiphysis is the last of the long bones to appear (18- 20) and close (23-25)
- 5. SC Joint Pathology •Instability • Arthritis • Osteoarthritis • Post Traumatic
- 6. SC Joint Instability- Classification Direction - Anterior Anterior dislocation of the right SC joint
- 7. SC Joint Instability- Classification Direction - Posterior
- 8. SC Joint Instability- Classification Direction - Superior Management and functional outcomes following SCJ dislocation. Injury 2015.
- 9. SC Joint Instability- Classification • Direction • Anterior/Posterior/ Superior • Cause • Traumatic/Atraumatic With shoulder in extension, medial end of right clavicle is prominent
- 10. SC Joint Instability- Classification • Direction • Anterior/Posterior/ Superior • Cause • Traumatic/Atraumatic • Chronicity • Acute/Chronic • Severity • Sprain/Subluxation/ Dislocation
- 11. SC Joint Instability- Evaluation • High energy trauma • Football • MVA • Mediastinal compromise • Up to 50% • Examination
- 12. SC Joint Instability- Imaging • Routine radiographs are difficult to interpret • CT scan is the investigation of choice • MRI may distinguish between physeal injuries and SC joint dislocations (relevance?)
- 13. SC Joint Instability– 4D CT
- 14. SC Joint Instability- Acute Traction • Majority of SCJ injuries are managed non-operatively • There is role for reduction of acute posterior SC joint dislocations • Patients with mediastinal compromise CombinationTowel Clamp Difficult to achieve reduction with closed manoeuvres
- 15. SC Joint Instability- Acute • Open reduction may be justified given the high failure rate of closed reduction • Have a cardiothoracic surgeon available • Secure fixation with Mersilene Tape • Avoid hardware if at all possible
- 16. SC Joint Instability- Acute • Open reduction may be justified given the high failure rate of closed reduction • Have a cardiothoracic surgeon available • Secure fixation with Mersilene Tape • Avoid hardware if at all possible Dr. Sergei, Cardiothoracic Surgeon
- 17. SC Joint Instability- Acute • Open reduction may be justified given the high failure rate of closed reduction • Have a cardiothoracic surgeon available • Secure fixation with Mersilene Tape • Avoid hardware if at all possible Dr. Sergei, Cardiothoracic Surgeon
- 18. SC Joint Instability- Acute • Open reduction may be justified given the high failure rate of closed reduction • Have a cardiothoracic surgeon available • Secure fixation with Mersilene Tape • Avoid hardware if at all possible
- 19. SC Joint Instability- Outcome • 22 patients with acute SCJ dislocations • Average 3.5 years follow up (1-9 years) • SSV 88%, ASES 94 • Results maintained over time • Anterior chest avulsion (SSV 50%, ASES 62) Anterior chest avulsion
- 20. SC Joint Instability- Chronic • Figure of 8 reconstruction • Singer, et al (JSES 2013) • 6 athletes • Anterior or posterior instability • DASH 54 to 28 • All returned to full sporting activity Instability and Degenerative Arthritis of the SCJ. AJSM 2014
- 21. SC Joint Instability- Chronic • Figure of 8 reconstruction
- 22. SC Joint Pathology •Instability • Arthritis • Osteoarthritis • Post Traumatic
- 23. SC Joint Arthritis •Non operative Management • Rest/Ice • NSAIDs • Activity modification • I/A Cortisone
- 24. SC Joint Arthritis •Operative Management • Resection of medial clavicle • ~ 1cm to preserve the costo- clavicular ligaments • May be done arthroscopically • Pingsmann JBJS-Br 2002 • 8 females • 31 month follow up • 7/8 reported high level of pain relief
- 25. Is it safe? •Be prepared • Cardiothoracic Support • What to do • Reverse Trendelenburg • Moist pack in the wound to avoid an air embolus • Osteotomy of the clavicle for surgical access
- 26. In Conclusion • Majorityof SC joint dislocations are anterior and can be managed non operatively • SC joint arthritis may be painful and can be treated with surgical excision Ash Moaveni, Melbourne ash@moaveni.com.au