Incarcerated Sternoclavicular Joint Intra-articular Disc Following Closed Reduction of a Posterior Dislocation Leading to Recurrent Anterior Instability

TL;DR

A teenager with a sternoclavicular joint dislocation had recurring issues after treatment, leading to the recommendation for MRI scans post-treatment.

Contribution

The paper highlights the importance of MRI scans after closed reduction to assess soft tissue status and prevent recurrent instability.

Findings

Closed reduction of a posterior SCJ dislocation can lead to incarcerated intra-articular disc and capsule tears.

MRI arthrogram revealed soft tissue damage not evident on CT scans.

Open excision and tendon graft reconstruction resolved the recurrent instability.

Abstract

Traumatic posterior dislocations of the sternoclavicular joint (SCJ) are rare. One option for management is to undertake a closed reduction within 48 hours, confirmed by a post-reduction computed tomography (CT) scan.

We describe the case of a 17-year-old male patient who sustained a posterior SCJ dislocation that was treated within 48 hours by a closed reduction confirmed by CT. However, he went on to develop recurrent SCJ instability. A magnetic resonance imaging (MRI) arthrogram demonstrated that the intra-articular disc had been incarcerated at the back of the joint at the time of reduction and tears to both the anterior and posterior capsule. He underwent a successful open excision of the disc and hamstring tendon autograft reconstruction.

Following closed reduction for an acute posterior SCJ dislocation, we would recommend undertaking a post-reduction MRI scan to confirm the reduction and status of the soft tissues.

Figures