Atraumatic Sternoclavicular Joint Dislocation at Inpatient Rehab

Case Diagnosis: Atraumatic sternoclavicular joint dislocation

Case Description or Program Description: A 26-year-old right-hand-dominant male was at inpatient rehab (IPR) after a car accident resulted in a severe traumatic brain injury and right shoulder AC joint separation, among other injuries. He was progressing well at IPR until he woke up one morning with worsened pain and swelling over his right sternoclavicular joint, decreased range of motion in his shoulder and a significant deformity with skin tenting without threatening over his SC joint. These symptoms were thought to be due to a sternoclavicular joint dislocation. The patient was then seen by Orthopaedics in the Emergency Department where x-rays were not conclusive for dislocation. He was discharged back to IPR with a sling for comfort.

Setting: Inpatient Rehabilitation

Assessment/Results: After discharge from IPR, the patient was seen in Orthopaedics clinic by a shoulder specialist who subsequently ordered a CT scan of the chest which was notable for an anterior dislocation of the right sternoclavicular joint with some subsequent bony callus formation. The patient underwent a sternoclavicular joint reconstruction with orthopaedics, but unfortunately had repeat dislocation 6 months after reconstruction.

Discussion (relevance): Traumatic sternoclavicular joint dislocation or injury is a common reason for clavicle instability and sternal pain, but frequently occurs with significant trauma such as a high-speed MVC or fall from height directly onto the shoulder. This case describes an atraumatic idiopathic case of a sternoclavicular joint dislocation. Cross-sectional imaging, especially CT, can be a helpful imaging modality and accurately diagnose an SC joint dislocation.

Conclusions: On rare occasions, atraumatic sternoclavicular joint dislocation can occur, especially in individuals with recent trauma to the joint. If clinically concerned about either traumatic or atraumatic sternoclavicular joint dislocation, CT imaging is superior to x-ray to most accurately determine 3-D joint position to evaluate for dislocation.