A 25-year-old male player presented acutely after a fall onto his right shoulder. He described falling directly on to the shoulder, experiencing a cracking sensation and being unable to move the entire upper right extremity due to pain. At the time of his presentation he was found to have a global restriction of his shoulder movements as well as a deformity (visible and palpable) of the medial aspect of the right clavicle. There were no neurovascular symptoms or signs, he had no issues with swallowing and did not have any airway issues.
An AP x-ray image suggests a posterior dislocation of the right sternoclavicular joint. A CT scan was then conducted to better define the injury. Coronal CT images confirm a posterior dislocation of the clavicle (without any evidence of a fracture). Subsequent post-surgical x-ray images show satisfactory reduction of the injury with surgical stabilisation.
The player was managed with early surgical stabilisation of the injured joint. Open reduction and internal fixation was completed, taking care of the blood vessels of the subclavian bundles. After the surgery, the player was immobilised in a sling for four weeks. At this point he started a physical therapy programme involving range of motion exercises and progressive strengthening exercises. He is expected to return to play between 3-6 months following his injury.
Dislocations of the SCJ are not common injuries among football players. When dislocations do occur, they generally occur in the anterior direction. Posterior dislocations are relatively rare injuries and are associated with a higher rate of complications. This is because of the close relationship to the innominate artery, innominate vein, trachea, oesophagus, and thoracic duct. As a result, posterior dislocations are generally managed as an emergency. A close history and examination assessing for dysphagia, shortness of breath and neurovascular symptoms is very important.
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