Posterior Sternoclavicular dislocation

[Martine42]

Posterior Sternoclavicular dislocation - my seventeen year old son suffered this rare dislocation playing rugby. He was sent home from hospital after two days with a figure of eight bandage and told that it might relocate spontaneously.
Should I seek a second opinion? Would other treatments be more successful? How long have we got to sort this out? What will his range of movement be if it doesn't relocate? More importantly is it dangerous, could the dislocated clavicle really cause life threatening neurovascular injury? Is there an orthopedic specialist near Wales who would take this case on? The accident happened 6/2/08.

[JainMD]

Hi,
How is your son feeling?
Posterior Sternoclavicular dislocation is when medial end of the clavicle dislocates from its articulation with the sternum.
Posterior dislocations may cause neurovascular or respiratory compromise.
Several vital structures lie immediately posterior to the sternoclavicular joint like Innominate artery and vein, Trachea, Esophagus, Vagus and phrenic nerves and anterior jugular vein.
Posterior dislocation can cause compression of these structures.
CT scan study will provides most information about a sternoclavicular dislocation and is the study of choice if a sternoclavicular joint dislocation is suspected.  It shows the bony anatomy of the dislocation and also shows what, if any, structures are being compressed in a posterior dislocation.
I think if you have a posterior dislocation then consider using CT angiography to see for compression of structures.
Posterior dislocations always should be reduced and usually are stable thereafter.
What traction technique the surgeon has used while reducing the joint dislocation?
What activity level he has planned and allowed for your child?
What about his physical therapy and medications?
Keep me informed if you have any queries.
Bye.

[Martine42]

Hi,
Thanks for your comments and kind consideration.
Jack feels ok , taking his treatment seriously, can lift his arm up to shoulder height, wants it put back in.

He had an MRI scan at the hospital on Friday but we don't know the results.
Not sure what a CT angiography is.
His traction is a removable harness holding both shoulders back.

Is this what is meant by reduction or is reduction a surgical procedure?

It sounded like they will not be doing any surgery .

We have an appointment back at the hospital in two weeks but I am worried and will be seeing our GP tomorrow.

Thanks again,
Martine

[JainMD]

Hi,
What I mean by reduction is that the dislocated joint is put back to its original place with help of brace or cast.
Exactly if the joint after reduction is stable then you need not do any further operation.
Keep me informed what the GP has to say about this.
Bye.

[Martine42]

HI,
Thanks I understand a bit better now, having spent three hours looking up case studies, etc on internet.

I can find no other cases where the patient is dismissed from hospital with the joint  still dislocated , like my son.

I have decided to go to a different hospital, probably my local one although I am also considering travelling to a specialist orthopaedic hospital.

Time would appear to be running out, as most closed reductions are done at the time and certainly within a week.

Fingers crossed, we find the right person and the right treatment.
Thanks

[JainMD]

Hi,
I am sorry I understood that he is better now with the help of first reduction.
If the joint is still dislocated then you must be seeing an orthopaedician as early as possible. Get an imaging study done as soon as possible.
The affected arm should be immobilized for 4 to 6 weeks after reduction.
Patients may benefit from sleeping upright (i.e., in a recliner) for pain relief and comfort.
Keep me informed if you have any queries.
Bye.

[Martine42]

Hi,
This is what worries me after two nights in hospital, a CT scan, the orthopaedic doctor discharged him without any reduction. The joint is still dislocated. They say they will leave it. I am determined that he will recieve the correct treatment.

We have an orthopaedic appointment at another hospital tomorrow but they to seem inclined to leave it dislocated and let the scar tissue build up.

We also have an appointment with another orthopaedic consultant at another hospital on Thursday, who sounds like he knows something about these dislocations.

So far everyone feels they should leave it because of the close proximity to the vital structures and ,I assume, Lack of experience of closed reduction of this kind.

I feel time is running out. It is now 5 days after the initial injury.

All the best.

[JainMD]

Hi,
I appreciate your feeling that you need get everything done as early as possible as there are vital structures in close proximity.
All the best and take care of your son till you make him reach for best of the treatment as soon as possible.
I would like to mention again that let his arm be immobilized completely as you are switching from one hospital to another.
The affected arm should be immobilized for 4 to 6 weeks after reduction.
Patients may benefit from sleeping upright (i.e., in a recliner) for pain relief and comfort.
Which part of the world are you from?
What does the CT scan report says?
Keep me informed and I hope for the best.
Bye.

[Martine42]

Hi,
We are from Wales, Great Britain.
CT showed 90% dislocation and not too close proximity to trachea, etc.
Will keep you posted.
Martine.

[JainMD]

Hi,
I am surprised that in Wales you are not getting a doctor who can do reduction for posterior dislocation.
The CT report has eased up my mind that it is not close to trachea.
What about vascular anatomy? Are there any which are close?
Keep me posted.
I should hear good news as you would be meeting another consultant today.
Good Luck.
Bye.

[Martine42]

HI,
Actually saw the CT scan today for first time - it made me realise the severity of the dislocation. But I did not identify vascular/trachea myself. I will make sure it is made clear to me at our next appointment.

The Orthopaedic doctor we saw today again said he would leave it dislocated as closed reduction would not work as it would pop out again,. and open reduction with pins would cause arthritus in the joint and the wires are too dangerous in case they come loose.

I really can't believe that the two orthopaedic doctors we have seen will not do anything.

Last, and most promising chance comes on Thursday. I asked formally for a second opinion and we have been refered to a Mr Hodinot, at Orthopaedics, in Morriston Hospital, Swansea. I was told he has written a book about the injury.

Must stay positive and expect the very best treatment for Jack.

All the best,
Martine

[JainMD]

Hi,
Keep me informed.
Bye.

[Martine42]

SUCCESS!

Jack will have open reduction on Tuesday with an expert in this rare condition, he has written two papers on the importance of diagnosis and one on a safe method of holding the joint in place with sutres.

Due to its rarity, Jack will be his fourth patient in a number of years.

Thoracic consultants will be standing by.
He will put the clavicle back in to the sternum joint, it will either stay in or pop out immediately, in which case he will drill holes in the sternum and end of bone and join with safe sutres.

I AM SO HAPPY...I hope everyone continues in their search for the very best treatments until they are 100% satisfied. This will all be done on the national health, by the way.

[JainMD]

Hi,
That’s great news; you have finally found the best doctor for your child. You have finally succeeded in your quest to find the best doctor.
What is his name? Which paper he has published? Where is he based?
Keep me informed about of surgery and its recovery.
Bye.  

[Martine42]

Hi,
His name is Mr Hoddinott, he works at Morriston Hospital in Swansea.
He has written two papers on posteriro sternoclavicular dislocation one on importance of early diagnosis and one on his new safe method of using sutres instead of pins or wire.

My son Jack was his fourth operation of this kind.
Jack had the operation last Thursday and came home the next day.

Mr. Hoddinott, drilled a hole in the end of clavicle and sternum and joined with sutres.

Jack must hold his arm bent and still for three weeks.

Physio involves moving his neck from side to side and lifting bent arm slightly forward and up and down to keep shoulder joint mobilised.

Yes, it feels like a great victory to get such wonderful treatment! We have an appointment with Mr Hoddinott in two weeks, I will let you know.

Thanks for your support.

Martine

[remingce]

Hi,

I saw this discussion chain and I was hoping to get some information from either of you.  I suffered a posterior sternoclavicular dislocation about 4 years ago while playing D1 college field hockey.  The doctors that initially saw me said nothing was wrong, but a second opinion, CT scan, and X-ray showed it to be dislocated.  The second doctors tried to perform a closed reduction, without success.  They told me that I should be ok leaving it dislocated.  I've not been in much pain, but my throat always feels like it's being pressed on and I feel like I have to push my shoulder back to relieve the pressure.  I also have knots under that side's shoulder blade.  Occasionally I'll do something that causes a sharp pinching pain.  I'm considering my options for surgery and I was hoping one of you might be able to share your experiences.

Thanks,
Courtney