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Adolescent Sternoclavicular Joint Injury



- See: SC Joint Injury

- Medial SC Joint Injury:
    - injury is due separation of proximal clavicular physis rather than dislocation;
    - need to determine if proximal clavicular metaphysis (distal fragment) is anterior or posterior;
    - anterior and superior displacement of medial end of clavicle or x-ray appearance of  SC joint separation indicates a Salter Harris type I or type II separation of medial clavicular epiphysis;
    - anterior displacement:
          - require only symptomatic treatment;
    - posterior displacement:
          - more symptomatic, can displace vital thoracic outlet structures, and require manipulative reduction;

- Radiographs:
    - medial epiphysis does not ossify on radiographs until the pt is 18 yrs, and does not fuse until age 23-25 yrs;
    - if fragment is posterior, it appears more caudad than normal side on x-rays taken w/the beam was pointed obliquely toward the sternum in a cephalad direction;

- Treatment:
    - anterior SC joint injuries typically heal satisfactorily w/ a shoulder immobolizer;
           - as a periosteal sleeve or tube is maintained (adequate remodeling potential exists);
    - posterior displacement in an asymptomatic adolescent should be closed reduced, & there is little indication for open reduction



Spontaneous atraumatic anterior subluxation of the sternoclavicular joint.