Collarbone dislocation are a complete displacement of the acromial or sternal end of the clavicle relative to the process of the scapula or sternum. There is pain and swelling, an increase in the standing of collarbone dislocation site. Limb movements on the affected side are severely limited. Diagnosis is carried out according to the results of a clinical examination, anamnesis of damage and radiography data. According to the indications, an MRI or CT scan is additionally prescribed. Treatment is conservative (using special plaster dressings) or operative (by fixing the articular end of the clavicle with dacron threads).
Collarbone dislocation are often found in clinical practice and account for about 5% of the total number of dislocations. Mostly middle-aged men suffer. Since the clavicle is involved in the formation of two joints (with the acromial process of the scapula and with the sternum), two types of dislocations may occur: in the sternoclavicular and acromial-clavicular articulation. Dislocation of the acromial end of the clavicle is about 5 times more common.
There are several mechanisms of traumatic injury:
- Occurs as a result of falling on the shoulder or the withdrawn arm.
- Dislocated by a direct impact or when a heavy load falls on the area of the upper arm.
- Rarely, the cause of dislocation is a sharp compression of the upper arms in the transverse direction.
The direct mechanism is usually noted with dislocation of the acromial, indirect – with damage to the sternal end of the clavicle.
The collarbone is the only bone that binds the bones of the upper limb to the bones of the trunk. With its sternal end, it attaches to the sternum. The acromial end of the bone connects to the acromial process of the scapula. In both cases, joints are formed – sedentary joints of bones, each of which is reinforced with strong ligaments. Damage occurs when exposed to a traumatic force exceeding the strength of the ligaments. If the integrity of one ligament is violated, a subluxation is formed, if both ligaments are torn, a complete dislocation is formed.
If up to 3 days have passed since the dislocation of the sternal or acromial end of the clavicle, such a dislocation is considered fresh, from 3 days to 3 weeks – stale, more than 3-4 weeks – old. Depending on the localization and degree of damage in traumatology and orthopedics, there are:
- Complete dislocation of the acromial end of the clavicle – the cranio-clavicular ligament, capsule and ligaments of the acromial-clavicular joint are damaged.
- Incomplete dislocation in the acromioclavicular joint – the acromioclavicular ligament is torn, the clavicular remains intact.
- Complete dislocation of the sternal end of the clavicle – the integrity of the sternoclavicular and costoclavicular ligaments is violated.
- Incomplete dislocation of the sternoclavicular joint – the sternoclavicular ligaments are damaged, the costoclavicular remains intact.
The sternal end of the clavicle can be dislocated in three directions: upward (supra-sternal dislocation), backward (retro-sternal dislocation) and forward (anteropostal dislocation). anteropostal collarbone dislocation is more often observed.
Dislocation of the acromial end of the clavicle
The patient complains of pain in the area of injury. There is a local swelling of soft tissues. The acromial end of the clavicle protrudes upwards and slightly posteriorly. A “key” symptom appears: when pressing on the protruding end of the clavicle, it falls into place, and when the pressure stops, it rises again. Palpation of the injury site is painful, movements are limited.
The degree of protrusion of the acromial end of the clavicle depends on the severity of the injury. With incomplete collarbone dislocation, the protrusion is expressed slightly or moderately. If the patient’s arm is pulled down, the collarbone together with the shoulder will move down, the degree of clavicle standing will not change. With complete dislocations of the collarbone, pulling the patient’s arm down is accompanied by an increase in protrusion.
Dislocation of the sternal end of the clavicle
The patient complains of pain in the area of the sternoclavicular joint. Edema and deformity are visually determined. With an anterior–thoracic collarbone dislocation in the area of damage, protrusion is detected, with anterior – thoracic – occlusion. In the supraorbital type of injury, the end of the bone will stand above the tip of the sternum. Palpation is painful, there is a restriction of movements. With the chest variant of the injury, symptoms of compression of the respiratory tract are rarely detected.
Long-standing dislocations of the collarbone
Incomplete long-standing dislocation of the acromial end of the bone can occur almost asymptomatically. The only complaint of patients is sometimes a deformity of the acromioclavicular joint. With complete long-standing acromial dislocations, patients are concerned about pain in the area of injury and a decrease in arm strength. Long-standing sternal dislocations are accompanied by the formation of a cosmetic defect, usually proceed without pain and movement disorders.
Severe complications and severe disability in the long-term period are uncharacteristic. In some patients, even after timely reduction, instability of the damaged joint and pain are detected against the background of insufficient fusion and scarring of ligaments, With acromial dislocations, limited mobility of the shoulder joint is rarely detected (usually minor or moderate).
Collarbone dislocation, as a rule, does not cause doubts due to the presence of a characteristic clinical picture. The diagnosis is verified by a traumatologist in a trauma center or emergency room. The following methods are used:
- External inspection. The diseased upper arm is shortened. Edema and visible deformity are detected in the affected area. Palpation is painful. With acromial dislocation, the end of the clavicle is raised above the shoulder joint in the form of a step, when feeling, you can insert a finger between the clavicle and the acromial process. With injuries to the sternal end, an offset corresponding to a particular type of dislocation is determined.
- X-ray examination. To confirm, a snapshot of the acromioclavicular joint or a chest x-ray is performed. With incomplete dislocations of the clavicle, in some cases, a comparative radiograph of both joints is required, sometimes with a functional load (the patient picks up a small load).
In traumatology, incomplete acromial dislocation is usually treated conservatively. The displacement of the bone is eliminated by pulling the shoulder back and simultaneously pressing on the protruding end of the clavicle. Then the immobilization of the acromioclavicular joint is performed for a period of 2-3 weeks. Subsequently, physiotherapy and physiotherapy are prescribed: electrophoresis, magnetotherapy, ozokeritotherapy.
With dislocation of the sternal end, the reduction is carried out without much difficulty, but it is not always possible to keep the collarbone in place. The assistant pulls the patient’s shoulders back, while the traumatologist corrects the position of the clavicle by removing it from behind the sternum or pressing. There is a special conservative method of treatment, in which an eight-shaped plaster cast is applied after reduction. The patient is prescribed physical therapy.
With complete acromial dislocations, plastic articulation is often indicated, since it is very easy to put the acromial end of the clavicle in place, but due to the peculiarities of the anatomical structure of this area, it is almost impossible to keep it in the correct position. During the operation, an orthopedic traumatologist sets the collarbone and fixes it with a dacron ribbon or silk thread. In some operating procedures, additional fixation with a spoke is used.
With fresh chest dislocations of the clavicle, surgical methods of treatment are also used in most cases. Lavsanoplasty is used to restore ligaments. Usually, the operation is carried out as planned a few days after the treatment. In case of chest injuries, especially those accompanied by respiratory disorders, intervention is performed urgently. Long-standing dislocations of both ends of the collarbone can be eliminated only with the help of surgery, as indications for which both pain and movement disorders and a cosmetic defect can be considered.
Prognosis and prevention
With timely treatment, the prognosis is favorable. If the collarbone dislocation cannot be eliminated in a conservative way, operations are performed that provide good aesthetic and functional results. In the absence of treatment, the deformity persists throughout life, the degree of dysfunction is moderate, insignificant or absent, the likelihood of developing a chronic pain syndrome increases compared to timely treated dislocations. Preventive measures include the prevention of injuries at home and at work.