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Plath JE, Martetschläger F, Moroder P, Sandmann G. Instabilities and Osteoarthritis of the Sternoclavicular Joint. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024; 162:360-367. [PMID: 37647924 DOI: 10.1055/a-2109-3190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Injury to the sternoclavicular joint (SCG) is very rare, accounting for 3% of shoulder injuries and < 1% of instabilities. Consequently, both the treatment of acute instabilities and their subsequent states (chronic instabilities/SCG arthrosis) are controversial. While treatment has so far been mostly conservative, in recent years there has been a trend towards surgical therapy.Considerable violence, such as that found in traffic accidents or contact sports, can tear the extremely stable ligaments between the medial clavicle and sternum. While anterior dislocation is easier to reduce in most cases, instability remains in up to 50% of cases. In most cases, posterior instability requires rapid reduction, particularly due to the anatomical proximity to important cardio-pulmonary structures. If this succeeds, the rate of persistent instabilities is low. For chronic instability, reconstruction/augmentation of the ligament apparatus with tendon grafts in the "Figure of 8 configuration" has proven to be the standard technique in recent years.
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Affiliation(s)
| | | | - Philipp Moroder
- Abteilung Schulterchirurgie und Ellenbogenchirurgie, Schulthess Klinik Zürich, Zürich, Schweiz
| | - Gunther Sandmann
- Sportklinik Ravensburg, Sportklinik Ravensburg, Ravensburg, Deutschland
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2
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Kou X, Zhan J, Xie W, Jiang K. Treatment of an adult with osteoarthritis of the sternoclavicular joint combined with congenital myotonic strabismus. Asian J Surg 2023; 46:5614-5615. [PMID: 37591746 DOI: 10.1016/j.asjsur.2023.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/06/2023] [Indexed: 08/19/2023] Open
Affiliation(s)
- Xianshuai Kou
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, 730000, China
| | - Jinhua Zhan
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, 730000, China
| | - Wendong Xie
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, 730000, China
| | - Kan Jiang
- Department of Orthopedics, Gansu Provincial Hospital, Lanzhou, 730000, China.
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Gobbell W, Edwards CM, Engel SR, Coyner KJ. Atraumatic Sternoclavicular Joint Instability: Prevalence, Etiology, and Management. Clin Sports Med 2023; 42:723-737. [PMID: 37716734 DOI: 10.1016/j.csm.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Sternoclavicular joint instability is a rare complaint in the orthopedic clinic, but patients can experience chronic pain and functional impacts. Causes of instability may be posttraumatic, infectious, autoimmune, degenerative, or secondary to generalized laxity. Conservative treatment is the initial approach to management and involves activity modification, physical therapy, oral nonsteroidal anti-inflammatory drugs, and corticosteroid injections. Surgery is indicated when conservative treatment does not manage symptoms. Figure-of-eight reconstruction techniques provide greatest biomechanical strength but are associated with risk of neurovascular injury. Other reconstruction methods have been shown to mitigate these risks with favorable short-term outcomes.
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Affiliation(s)
- Wade Gobbell
- Department of Orthopedic Surgery, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA
| | - Christopher M Edwards
- Department of Orthopedic Surgery, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA
| | - Samuel R Engel
- Department of Orthopedic Surgery, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA
| | - Katherine J Coyner
- Department of Orthopedic Surgery, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA.
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Min KS, Lopez A, Powlan FJ, Pham B, Lause G. Ultrasound-guided sternoclavicular joint injection: technique and case series. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:393-397. [PMID: 37588724 PMCID: PMC10426650 DOI: 10.1016/j.xrrt.2021.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Sternoclavicular joint pathology can be an uncommon cause of pain and discomfort around the neck and shoulder region. Typically, patients localize their pain deep to the joint and experience referred pain to the ipsilateral neck and shoulder; however, it often presents as a diffuse nonspecific pain. Given the paucity of this pathology and atypical presentation, the use of injections can be helpful to confirm the diagnosis of sternoclavicular arthropathy. Currently, most injections are done via computed tomography. Although this method is accurate, it exposes patients to radiation and burdens the patient with the requirement of multiple appointments. This case series outlines the use of ultrasound-guided sternoclavicular joint injections conducted in the clinic. The patients in this series underwent an ultrasound-guided injection in the affected sternoclavicular joint, which confirmed the diagnosis, and they were subsequently treated with resection arthroplasty. The use of ultrasound-guided injections of the sternoclavicular joint is a safe and accurate alternative diagnostic method, which saves the patient from harmful radiation and additional appointments. Limitations and efficacy may vary depending on skill and comfort level of the operator.
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Affiliation(s)
- Kyong S. Min
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI, USA
| | - Andrew Lopez
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI, USA
| | - Franklin J. Powlan
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX, USA
| | - Brandon Pham
- Michigan State University College of Osteopathic Medicine, Est Lansing, MI, USA
| | - Greg Lause
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI, USA
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Dey Hazra RO, Reich AR, Hanhoff M, Warnhoff M, Lill H, Jensen G. [Injuries of the sternoclavicular joint]. Unfallchirurg 2020; 123:879-889. [PMID: 33048209 DOI: 10.1007/s00113-020-00888-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Injuries of the sternoclavicular joint (SCJ) are rare accounting for 3% of all injuries to the shoulder girdle and are often overlooked. The SCJ is surrounded by tight ligamentous structures, thus substantial energy with corresponding force vectors is needed to cause dislocation. Causative are mostly high-energy traumas. Anterior dislocation is most common but in rare cases potentially life-threatening posterior dislocation occurs, which requires immediate reduction. The established gold standard is 3D reconstruction in contrast-enhanced computed tomography (CT) for depiction of neurovascular structures. Low-grade instability can initially be treated conservatively. For unsuccessful attempts at reduction, high-grade instability and chronic instability various surgical techniques are established. Next to retentive augmentation with suture materials, in acute cases with chronic instability biological tendon augmentation is preferred. In cases of posttraumatic instability arthritis SCJ resection with or without additive biological augmentation can be carried out. Various study groups have shown good to very good midterm outcome.
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Affiliation(s)
- Rony-Orijit Dey Hazra
- Klinik für Orthopädie und Unfallchirurgie, DIAKOVERE Friederikenstift Hannover, Humboldstr. 5, 30169, Hannover, Deutschland.
| | - Anne-Rieke Reich
- Klinik für Orthopädie und Unfallchirurgie, DIAKOVERE Friederikenstift Hannover, Humboldstr. 5, 30169, Hannover, Deutschland
| | - Marek Hanhoff
- Klinik für Orthopädie und Unfallchirurgie, DIAKOVERE Friederikenstift Hannover, Humboldstr. 5, 30169, Hannover, Deutschland
| | - Mara Warnhoff
- Klinik für Orthopädie und Unfallchirurgie, DIAKOVERE Friederikenstift Hannover, Humboldstr. 5, 30169, Hannover, Deutschland
| | - Helmut Lill
- Klinik für Orthopädie und Unfallchirurgie, DIAKOVERE Friederikenstift Hannover, Humboldstr. 5, 30169, Hannover, Deutschland
| | - Gunnar Jensen
- Klinik für Orthopädie und Unfallchirurgie, DIAKOVERE Friederikenstift Hannover, Humboldstr. 5, 30169, Hannover, Deutschland
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Garcia JA, Arguello AM, Momaya AM, Ponce BA. Sternoclavicular Joint Instability: Symptoms, Diagnosis And Management. Orthop Res Rev 2020; 12:75-87. [PMID: 32801951 PMCID: PMC7395708 DOI: 10.2147/orr.s170964] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/13/2020] [Indexed: 12/24/2022] Open
Abstract
Sternoclavicular joint (SCJ) instability is a rare condition and results from either a traumatic high energy impact, such as a motor vehicle crash or contact sports injury, or non-traumatically as a result of structural pathology. The infrequency of this injury has contributed to its diagnosis being missed as well as the paucity of literature on treatment and outcomes. Patients with SCJ instability often report diminished range of motion as well as shoulder girdle pain. The presentation of instability in the sternoclavicular joint can vary in severity and anterior or posterior directionality. Variation in severity of the instability changes the course of treatment regarding either operative or non-operative interventions to stabilize the SCJ. In general, anterior instability of the SCJ (the medial clavicle is displaced anterior to the sternum) is less urgent and generally manageable by symptom alleviation and rehabilitation, although some anterior instability cases require surgical intervention. In the case of posterior SCJ instability (the medial clavicle is displaced posterior to the sternum), patients require prompt joint reduction as they are at the greater risk of life-threatening injury due to the location of critical structures of the mediastinum posterior to the SCJ. Computed tomography visualization is useful to confirm dislocation or subluxation direction to better formulate a proper treatment plan. The purpose of this review is to report the clinical presentation and management of SCJ instability including pertinent symptoms, the diagnostic approaches to evaluating SCJ instability, as well as operative and non-operative management of the joint instability.
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Affiliation(s)
- Jacob A Garcia
- University Of Alabama At Birmingham School Of Medicine, Birmingham, AL 35294, USA
| | - Alexandra M Arguello
- University Of Alabama At Birmingham, Department Of Orthopedic Surgery, Birmingham, AL 35294, USA
| | - Amit M Momaya
- University Of Alabama At Birmingham, Department Of Orthopedic Surgery, Birmingham, AL 35294, USA
| | - Brent A Ponce
- University Of Alabama At Birmingham, Department Of Orthopedic Surgery, Birmingham, AL 35294, USA
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Editorial Commentary: Sternoclavicular Joint Osteoarthritis Surgical Treatment Offers Benefits as Well as Risks. Arthroscopy 2020; 36:1230-1232. [PMID: 32370885 DOI: 10.1016/j.arthro.2020.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 02/02/2023]
Abstract
Sternoclavicular (SC) joint surgical procedures have risks as well as benefits and should be performed by experienced surgeons with a good understanding of the neurovascular anatomy and with a thoracic surgeon on call. Computed tomography angiograms to evaluate the proximity of the SC joint to the blood vessels are essential for preoperative planning. Care must be taken to exclude instability as a cause of SC joint symptoms, and surgeons must avoid causing iatrogenic instability. Both arthroscopic and open approaches can result in excellent clinical outcomes for patients with symptomatic SC arthritis. We prefer an open approach because an arthroscopic approach may have a greater risk of complications. In our experience, after surgical treatment of SC arthritis, 67% of patients return to sport at 2-year minimum follow-up.
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