Dislocation of the clavicle: causes, symptoms, diagnosis, treatment

ICD-10 code

• 543.1. Dislocation of the acromioclavicular joint.
• 543.2. Dislocation of the sternoclavicular joint.

Clavicle dislocation accounts for 3-5% of all dislocations.

What causes a dislocated collarbone?

They occur mainly as a result of an indirect mechanism of injury: a fall on the shoulder or an abducted arm, a sharp compression of the shoulders in the frontal plane.

Dislocation of the clavicle (acromial end)

ICD-10 code

S43.1. Dislocation of acromioclavicular joint.

Anatomy

On the outside, the clavicle is held in place by the acromioclavicular and coracoclavicular ligaments.

Classification of clavicle (acromial end) dislocation

Depending on which ligament is torn, a distinction is made between complete and incomplete dislocations. If one acromioclavicular ligament is torn, the dislocation is considered incomplete; if both are torn, it is considered complete.

Symptoms of a dislocated clavicle (acromial end)

Complaints of pain in the acromial joint area, moderately limiting movement in the shoulder joint.

Diagnosis of clavicle (acromial end) dislocation

Characteristic mechanism of injury in the anamnesis. Edema and deformation are noted at the site of injury. Its severity depends on what kind of dislocation we are dealing with: complete or incomplete. In complete dislocations, the acromial end stands out significantly, its outer surface can be felt under the skin, and when the scapula moves, the clavicle remains motionless. In incomplete dislocations, the clavicle maintains a connection with the scapula through the coracoclavicular ligament and moves together with the scapula; the outer end of the clavicle cannot be felt. Palpation is painful in all cases.

When pressing on the collarbone, the dislocation is quite easily eliminated, but as soon as the pressure is stopped, it occurs again. This is the so-called "key symptom" - a reliable sign of a rupture of the acromioclavicular joint.

Laboratory and instrumental studies

Radiography facilitates diagnosis. When reading radiographs, one should pay attention not so much to the width of the joint space (its size is variable, especially with incorrect placement), but to the position of the lower edge of the clavicle and the acromial process. If they are at the same level, it means that the ligamentous apparatus is intact and there is no dislocation, and upward displacement of the clavicle is a sign of pathology.

Treatment of dislocation of the clavicle (acromial end)

There are conservative and surgical methods of treating dislocation of the clavicle (acromial end).

Conservative treatment of clavicle (acromial end) dislocation

Repositioning the dislocated acromial end of the clavicle is not difficult, but holding it in the desired position using conservative methods is quite difficult. Various bandages, splints and devices are used for fixation, supplemented by a pad that presses on the acromial joint. Let's consider some of them.

Volkovig's bandage. After anesthetizing the injury site with 20-30 ml of 1% procaine solution, the clavicle is reset. A cotton-gauze pad is applied to the acromioclavicular joint area, fixed with a strip of adhesive tape from the acromial process over the shoulder back and down, then along the back of the shoulder, around the elbow joint and back along the front of the shoulder to the starting point. The bandage is applied with the shoulder abducted outward and back. A small roller is inserted into the axillary region, the arm is lowered, fixed with a sling.

Another method of fixing the pad is to apply a bandage with the shoulder abducted from the shoulder girdle to the lower third of the shoulder along the outer surface. Fixation is reinforced with a second strip, running perpendicular to the first (crosswise). The arm is lowered, which increases the tension of the patch and the retention of the collarbone. Both adhesive bandages should be reinforced with a Desault bandage.

A plaster cast is the most common method of fixation. Various modifications of thoracobrachial casts, Desault plaster casts and others are used, but with the obligatory use of pads.

The immobilization period for all conservative methods is 4-6 weeks. Subsequently, rehabilitation treatment is indicated.

Surgical treatment of clavicle (acromial end) dislocation

If conservative treatment is unsuccessful and in the case of chronic dislocations, patients should be referred to a hospital for surgical treatment.

Its essence lies in the creation of acromioclavicular and coracoclavicular ligaments from autogenous tissues, allotissues or synthetic materials (silk, nylon, lavsan). The most frequently used operations are those by the Bohm, Bennel and Watkins-Kaplan methods.

After surgery, a plaster thoracobrachial cast is applied for 6 weeks.

The simple operations of restoring the acromioclavicular joint with pins, screws, suturing and other similar methods without plastic surgery of the coracoclavicular ligament should not be performed due to the large number of relapses. The coracoclavicular ligament is the main ligament responsible for holding the clavicle.

Approximate period of incapacity

Working capacity is restored within 6-8 weeks.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ], [ 7 ], [ 8 ]

Dislocation of the clavicle (sternal end)

ICD-10 code

S43.2. Dislocation of sternoclavicular joint.

Classification of dislocation of the clavicle (sternal end)

Depending on the displacement of the inner end of the clavicle, there are presternal, suprasternal and retrosternal dislocations. The last two are extremely rare.

What causes a dislocated collarbone (sternal end)?

Dislocation of the sternal end of the clavicle occurs as a result of an indirect mechanism of injury: excessive deviation of the shoulder and supraclavicular region backward or forward.

Symptoms of a dislocated collarbone (sternal end)

The patient is bothered by pain in the sternoclavicular joint area.

Diagnosis of dislocation of the clavicle (sternal end)

The anamnesis shows a corresponding injury. A protrusion is detected in the upper part of the sternum (excluding retrosternal dislocation), which shifts when the shoulder girdles are brought together and spread apart and when breathing deeply. The tissues are edematous and painful when palpated. The shoulder girdle on the side of the injury is shortened.

Laboratory and instrumental studies

Radiography of both sternoclavicular joints in a strictly symmetrical position is mandatory. In case of dislocation, the sternal end of the clavicle shifts upward and toward the midline of the body. In the image, its shadow overlaps the shadow of the vertebrae and is projected higher compared to the healthy side.

Treatment of dislocation of the clavicle (sternal end)

Surgical treatment of dislocation of the clavicle (sternal end)

The best anatomical and functional results are achieved with surgical treatment of this injury.

The most common operation is performed using the Marxer method. The clavicle is fixed to the sternum with a U-shaped transosseous suture. An abduction splint or thoracobrachial plaster cast is applied for 3-4 weeks.

Approximate period of incapacity

Working capacity is restored after 6 weeks.

[ 9 ], [ 10 ], [ 11 ], [ 12 ], [ 13 ]

Classification of clavicle dislocation

Dislocations of the acromial and sternal ends of the clavicle are distinguished, with the former occurring 5 times more often. Very rarely is a dislocation of both ends of the clavicle detected simultaneously.

[ 14 ], [ 15 ]