Successful repair of thoracic outlet syndrome in a growing young patient due to posterior sternoclavicular joint dislocation

Abstract

Posterior sternoclavicular dislocation is an extremely rare injury, usually related to heavy trauma, such as a traffic accident. The anatomical proximity of vital mediastinal structures often discourages a closed reduction during emergency situations. In this case report, we present a 17-year-old male patient who was admitted to our emergency department after having fallen down a flight of stairs five days previously. He was eventually found to have thoracic outlet syndrome. Chest computed tomography (CT) and shoulder magnetic resonance imaging (MRI) showed a posterior dislocation of the right clavicular head with all sternoclavicular joint ligaments ruptured; a hematoma around the clavicular shaft; compression of the right brachiocephalic, subclavian, and internal jugular veins; compression of the brachial plexus; and the right hemopneumothorax. Emergent open reduction with sutures and simultaneous plate stabilization was conducted for the posterior sternoclavicular dislocation, and thoracic outlet syndrome was completely resolved by the seventh postoperative day. The plate was removed six months after the open reduction. Complete range of motion in the shoulder and no pain were achieved without any complications. Unlike other techniques, this technique, using both sutures reduction and simultaneous plate stabilization, will offer excellent results, especially in a growing, young patient.

Sports‐related peripheral nerve injuries of the upper limb

“…34 In the athlete, nerve compression within the thoracic outlet may arise acutely or as the result of chronic, repetitive use. Traumatic causes include bony instability or fracture involving the clavicle [35][36][37] or humerus. 38 More often, however, nTOS arises in the setting of repetitive activity, particularly repeated overhead and throwing activities.…”