Positional anterior sternoclavicular joint dislocation in the acceleration phase of throwing: a case report

Abstract

Positional anterior sternoclavicular joint (SCJ) dislocation is relatively rare and needs careful treatment. We report our course of treatment and tips for surgery in a case. The patient was a 16-year-old male outfield baseball player. Three years ago, he had 3 recurrent episodes of right shoulder dislocation. During these injuries, there were forward dislocations of the proximal right clavicle edge accompanied by a creaking sound during the throw acceleration period. Thereafter, the anterior dislocation of the SCJ occurred during the acceleration phase of throwing, and the SCJ naturally repositioned on the shoulder resting position. This situation lingered and he often felt shoulder apprehension during throws, so he opted for surgical treatment just 1 month after the first injury. We performed a modified version of the figure-of-8 technique reported by Wang et al, using the ipsilateral palmaris longus (PL) tendon. The bilateral edge of the PL was attached to a Krackow suture and passed through the bone tunnels opened at the proximal clavicle and proximal sternum so that it became a figure of 8 on the anterior of the SCJ. The stability of the SCJ was confirmed after the surgery.

Anterior Dislocation of the Sternoclavicular Joint – A Case Report

“…The prerequisite for causing SCJ dislocation is a powerful force of vector, which can only be seen during high-energy trauma like road traffic accidents (RTA), sporting accidents, or falls from height [3]. Previous literature also mentions RTA and sporting activities like motocross racing as major causes [3][4][5][7][8][9]. Heavy activity in the form of bench press in the gym has also been reported [10].…”

“…The SCJ has an extremely limited range of motion (ROM) of 35° forward/backward and 45° forward. Because of these minute degrees of ROM, the SCJ is a reasonably stable joint [ 7 ]. The posterior and anterior sternoclavicular ligaments, costoclavicular ligament, interclavicular ligament, and the strong joint capsule that surround the SCJ provide it with durable stability.…”

The Influence of Biomechanics in the Treatment of Posterior Sterno‐Clavicular Joint Dislocations

“…Therefore, posterior dislocations are less frequent and require major injuries and higher forces compared to anterior dislocations [14]. This event may show up also without any trauma in case of ligamentous laxity which needs to be treated in a conservative way [15]. Another reason that causes a higher frequency of anterior dislocations is that anterolateral blows are more common than postero-lateral ones, furthermore anterior capsule and the ligament is thinner [16].…”