Dislocation of the acromial end of the left clavicle. Dislocation of the acromial end of the clavicle: symptoms and treatment

In general clinical practice dislocations of the collarbone occur on average in 3-5% of all dislocations. This is very rare; for example, hip or arm dislocations are much more common.

Dislocations are classified according to the anatomical ends of the clavicle:

1. dislocation of the scapular (acromial) end of the clavicle.
2. dislocation of the sternal (sternal) end of the clavicle.

The first option occurs 5 times more often than the second.

Dislocation of both ends of the clavicle at the same time is extremely rare.

The mechanism of injury is indirect, that is, in as a result of falling on shoulder girdle or allocated to side hand, including with sharp compression in the frontal plane of the shoulder girdle.

Dislocation of the scapular (acromial) end of the clavicle.

Anatomically, the collarbone is fixed from the outside acromioclavicular And coracoclavicular ligaments Depending on which of the above ligaments was ruptured, the dislocation is classified as complete or incomplete. In case of damage to the acromioclavicular ligament, an incomplete dislocation is formed; if both ligaments are torn, a complete dislocation occurs.

Symptoms of a dislocated clavicle(acromial end) are:

1. Pain in the place acromion joint.
2. Limitation of limb movements on the affected side.
3. History of trauma with a characteristic mechanism.
4. Upon examination, swelling and deformation are noted in the area of ​​damage, the severity of which depends on the type of dislocation (incomplete or complete).
5. It is necessary to palpate the clavicle on the side of the injury and on the opposite side for comparison. In the case of complete dislocation, the acromial end protrudes significantly and it can be felt under the skin; when performing movements with the scapula, the collarbone is motionless. In the case of incomplete dislocation, the connection of the clavicle with the scapula is maintained through the coracoclavicular ligament, while when moving the limb, the outer end of the clavicle is not accessible to palpation. Palpation in all cases is sharply painful.
6. The “key symptom” when palpating the collarbone is the most reliable, i.e. when the dislocation is freely eliminated with pressure, and, in the absence of pressure, it reappears
7. Radiography is the most informative method of instrumental diagnostics. If the image shows a displacement of the collarbone, this is a clear signal of pathology.

Treatment of dislocation is divided into two types: conservative and surgical.

1. Conservative treatment is carried out by reduction of dislocation. For fixation, bandages, splints and other devices are used, supplemented with pressure on acromial joint by pilot.

Gypsum bandage- the most common method of treating dislocation. In this case, a plaster cast is used Deso or thoracobrachial bandages. In all cases, the use of a pilot is mandatory.

The period of immobilization with conservative treatment does not exceed 6 weeks. Subsequently, you should undergo a rehabilitation course.

2. The surgical method is indicated in case of failure of conservative treatment, as well as in old and repeated dislocations. Patients are subject to mandatory referral to a hospital for surgical treatment.

The method of surgical treatment involves the formation of acromioclavicular and coracoclavicular ligaments from allotissues, autologous tissues or synthetic materials (lavsan, silk, nylon). Upon completion of the surgical intervention, a plaster thoracobrachial bandage is required for up to 6 weeks.

The ability to work after dislocation of the acromial end of the clavicle will be restored no earlier than 6-8 weeks.

Dislocation of the sternal end of the clavicle

This dislocation is classified into presternal, suprasternal and retrosternal and depends on the direction of the clavicle displacement. Suprasternal and substernal are extremely rare.

Symptoms:

1. Pain in the projection of the sternoclavicular joint.
2. History of relevant injury.
3. During the examination, a protrusion of the collarbone above the sternum is noted, which shifts when the shoulder girdle is brought together and spread apart, as well as during deep breathing. The shoulder girdle on the side of the dislocation is somewhat shortened.
4. The tissues over the injury site are swollen.
5. Palpation is sharply painful.
6. It is necessary to perform x-rays of the sternoclavicular joints on both sides. In case of dislocation, the image will show a displacement of the sternal end of the clavicle towards the midline of the body and upward. The shadow of the sternal end of the clavicle will overlap the shadow of the vertebrae and is projected higher in relation to the healthy side.

Treatment is exclusively surgical in order to achieve optimal anatomical and functional results. The most common operation using the Marxer method, as a result of which the clavicle is fixed to the sternum using a U-shaped transosseous suture. Next, a thoracobrachial plaster cast or abduction splint is applied for 3-4 weeks.

With this pathology, ability to work will be restored after 6 weeks.

— online reference book on medicine

Injuries to the acromioclavicular joint are common injuries in orthopedic practice. Current literature confirms the effectiveness of conservative treatment for minor injuries. However, in case of significant displacements, surgical intervention is recommended to restore the kinematics (motor function) of the shoulder.

Most studies have focused on the use of ultra-strong synthetic materials in combination with biological grafts.

Clinical examination

As with any acute injury, if you suspect Acromiocleidoclavicular joint injury the doctor needs to carefully question and examine the patient, which will help determine the possibilities and timing of treatment, and possible consequences.

Pain in the shoulder girdle is typical for incomplete people. Increased pain during palpation and when performing provoking tests indicates local damage to the joint. A decrease in pain intensity in response to injection of local anesthetic confirms the diagnosis.

With complete ruptures, pain, swelling and deformation in the joint area are almost always detected.

Diagnostics

For the initial assessment of injuries to the shoulder joint, it is sufficient to performradiographyin three standard projections: anteroposterior, scapular, axillary.

The Zank projection (the emitter is in the anteroposterior projection, deviated by 10-15°) allows you to determine any displacement of the clavicle. Bilateral radiographs in this projection allow comparison with the opposite joint. An increase in the distance between the upper edge of the coracoid process and the lower edge of the clavicle by 25-30% (normally it is 1.1-1.3 cm) in comparison with the healthy side is regarded as a diagnostic sign of a complete rupture of the coracoclavicular ligament.

Classification of injuries to the acromioclavicular joint.

Most injuries to this joint are the result of the application of force to the acromion process directed from below when the arm is adducted. This movement moves the entire shoulder girdle down. As a result, either the collarbone is broken or the acromioclavicular ligament complex is damaged.

Consider the Rockwood classification, which starts with the minimum injuries of the acromioclavicular joint.

• Type 1 – sprain of the joint capsule and surrounding ligaments without displacement.
• Type 2 – rupture of the joint capsule and surrounding ligaments with a slight upward displacement of the clavicle, usually less than 50%.
• Type 3 – rupture of the acromioclavicular and coracoclavicular ligament complex leads to a 100% displacement of the clavicle relative to the scapula.
• Type 4 – The collarbone moves backward through the trapezius muscle.
• Type 5 – complete separation of the clavicle from the scapula with a displacement of up to 300%. This displacement occurs due to a rupture of the deltoid-trapezoid fascia.
• Type 6 – displacement of the clavicle downward and pinching it between the coracoid and acromial processes of the scapula. This type is extremely rare.

Treatment

For mild injuries of types 1 and 2, conservative tactics are the main one. The use of a supportive bandage that provides a comfortable position, alternating with the lifting of restrictions and symptomatic treatment of pain leads to excellent results. The use of corticosteroids and anesthetics may speed recovery.

Therapeutic tactics for injuries of types 4, 5, 6, on the contrary, almost always come down to surgical intervention.

Tactics for type 3 injuries are ambiguous. The general consensus is that this injury should first be treated conservatively, and in case of ineffectiveness and pathological manifestations persist for three months, surgical intervention should be resorted to.

At the moment, there are 2 types of operations - open and . For open operations with large access, hook-shaped plates are used (see photo 1), or structures that are installed from a minimally invasive approach (see photo 2.3.4).

Photo 2-3-4
Recently, the arthroscopic technique for performing plastic surgery of the coracoid ligament has been widely used. Each technique has advantages and disadvantages, but the undeniable advantage of the arthroscopic technique is its excellent cosmetic effect.

Rehabilitation and postoperative period

At the end of the operation, before the patient awakens, the arm is fixed with a tight support bandage. During the first postoperative visit, a control x-ray is performed, smooth movements in the hand, wrist and elbow joints are allowed. Movement in the shoulder joint is only in the supine position.

The support bandage is discontinued after 6 weeks, and a gradual transition to strength training is allowed by 4 months, and to contact sports by 6 months.

Conclusion

Arthroscopic reconstruction of the acromioclavicular joint is a developing method and is in its infancy. The concept of arthroscopic placement of a biological graft through or around the coracoid process using synthetic anchors is the basis of most techniques. Perhaps the most durable combination will be a free graft and a synthetic fixative, which will provide a lasting result.

No person at any age is immune from dislocation of the acromial end of the clavicle. Statistics show that 5% of all dislocations that occur on the upper limb occur at the acromial end of the clavicle.

Doctors in English-speaking countries refer to this injury as a shoulder tear, which is most likely due to the centuries-old roots of this term. Even in ancient Greece, Hippocrates shared the concept of “shoulder dislocation” and “dislocation of the acromial end of the clavicle”; before him, they were considered one type of injury. So two different traumas in a conversation have the same consonance.

In case of injuries to the shoulder area, you should immediately consult a specialist; self-medication and diagnostics are strictly prohibited.

Appearance of dislocation of the acromial end of the clavicle on the right

A dislocation is always accompanied by severe pain in the shoulder girdle, sometimes it becomes unbearable, especially when trying to move the arm. The damaged area protrudes and the positive “key” symptom is clearly visualized.

The “key” symptom gets its name due to the fact that checking it is reminiscent of pressing a key on a piano or grand piano. So in this case, pressing on the protruding area, it turns out to be a kind of pressing a key.

The site of injury is severely swollen, often accompanied by a hematoma, and it is impossible to move the injured limb. Damage can be diagnosed using x-rays.

First aid technique

After a person has been injured and there is a suspicion of dislocation of the acromial end of the clavicle, the first thing to start with is immobilizing the injured limb. This can be done by hanging the arm using a bandage or scarf.

WITH Making a scarf is very simple; for this you will need a piece of gauze or fabric measuring 1 x 1 meter, and bend it diagonally. The wide part is placed under the hand, and the sharp end is facing the elbow. The tails of the scarf are tied behind the person’s neck at a height so that the hand is comfortable and does not droop.

After an injury, swelling is observed at the site of injury; to reduce it, it is necessary to apply a cold compress. The duration of exposure to cold should be no more than 20 minutes with a break of half an hour. The cold should be wrapped in a cloth or rag, this way there is less risk of frostbite.

It is absolutely forbidden to adjust a dislocation on your own, as this can cause great harm to a person. An ambulance is immediately called to take the victim to the hospital and give a painkiller injection. .

Treatment

There are only two treatment options for dislocation of the acromial end of the clavicle. The first is conservative, and the second is operational. Each has its own indications and contraindications. What is the essence of this or that method?

With conservative treatment, the doctor carefully reduces the dislocated end, and then fixes it with a plaster. Before reducing the dislocation, the manipulation site is anesthetized, and then a roll of gauze or cotton wool is placed under the injured shoulder. The limb is stretched along the axis and at the same time the doctor presses on the collarbone; after everything is in place, a plaster cast is applied.

This method was previously widespread; after reduction, the person had to wear heavy immobilizing devices and plaster, all of which kept the collarbone in the correct position. In modern traumatology, these techniques have lost their significance. Wearing such a device was painful, and the dislocation could remain even after 6-4 weeks, when the bandage was removed.

Only incomplete dislocations or subluxations can be treated conservatively.

In the latter condition, bandages can be used, they are light and need to be worn for 3 to 5 weeks, the period is strictly individual and depends on the degree of damage to the joint capsule. After a control x-ray is performed, at the discretion of the doctor, the bandage can be removed and exercises can begin.

In most cases, conservative treatment does not give the desired effect and surgery is required. There are many methods of surgical intervention for a dislocated collarbone. Special buttons are used, they help to quickly return a person to normal life, but the likelihood of relapse is very high.

Screws can be used to securely fix the dislocation. After surgery, relapses are extremely rare. Most often, doctors use knitting needles to fix a dislocation. This option is the most acceptable for a person from a financial point of view.

Plastic surgery has the greatest effect; after its use, a person quickly recovers and can fully use the upper limb. The essence of the surgical intervention is to plasticize the ligaments and put them in place of the old ones, which are often torn. Afterwards, a cast is applied and the arm is fixed in a certain position. You will have to spend at least 1.5 months in this position with fixation.

Fixation with knitting needles

Fixing a dislocation with a knitting needle

The operation itself does not cause major injuries, and it can be performed without making an incision. The disadvantage of the technique is its low stability, due to the lack of restoration of damaged ligaments. The failure rate during surgery is 10–70%. Provided that the fixation is successful, the pins can be removed after 4-6 weeks; during this period, the damaged ligaments should heal completely.

Using a screw

More durable fixation can be achieved by using a screw that secures the clavicle to the coracoid process of the scapula. Surgical intervention using this technique is also characterized by a low level of trauma. To install the screw, it is enough to make an incision of only 3 to 5 centimeters. The fixation is reliable, but there is another side to the coin, which is a decrease in the mobility of the collarbone, due to which the mobility of the arm may not be completely restored.

Using buttons

A technique that involves the use of wire or strong thread and two metal buttons will help maintain normal mobility of the collarbone. This technique is called MINAR and to perform it you will need an incision of only three centimeters. Translated from English, the method stands for minimally invasive acromioclavicular reconstruction. The essence of the method is to position the fixator in such a way that it corresponds to the normal course of the damaged ligament fibers. Previously, they used lavsan thread, but today doctors have a more durable material at their disposal. Anchors and anchors may also be used and can be placed under arthroscopy guidance.

Use of the plate

Fixation using a plate with a hook is also widely used. Surgical intervention is reliable, but it also has its drawbacks. The first is as follows: to place the plate, you will need a large tissue incision (from 7 to 10 centimeters). The second is that the hook that the plate has is placed under the acromion of the scapula, and it is located next to the tendons that rotate the shoulder, and this can negatively affect them.

This circumstance forces the plate to be removed a few months after its placement, and this is another surgical intervention. There are cases when there is a fracture of the collarbone under the plate.

In case of chronic dislocation, partial removal of the acromial end of the clavicle will be required, and then plastic surgery of the ligaments using a graft from another part of the body.

Complications

After conservative treatment, asymmetry may develop

With a dislocation, there is a high probability of complications, the most common of which is a fracture of the collarbone. When realigned, the dislocation may not be completely eliminated and part of the bone may not return to its place. Any surgical intervention ends in the formation of a scar; it may not look aesthetically pleasing or become hypertrophied. If the wound is not properly cared for, the risk of infection is very high.

After a dislocation, arthrosis or growths in the area of ​​the acromioclavicular joint may develop, and movements in the limb may be limited.

The collarbone is one of the relatively unprotected and fragile bones in the human body and does not require much force to damage or dislodge it. Dislocation of the acromial end of the clavicle is a very common injury that occurs due to falls or awkward movements during exercise.

Hippocrates once described shoulder injuries, and it was he who distinguished between dislocations of the external (acromial) and internal (sternal) ends of the clavicle.

Dislocation of the outer end of the clavicle is classified into:

• incomplete (or subluxation) – rupture of one of the supporting ligaments;
• complete - rupture of both ligaments.

Such shoulder injuries can easily occur when falling on outstretched arms, for example, on a slippery surface or when falling on the side with the shoulder forward. Another cause of external shoulder dislocation can be a strong blow to the chest or shoulder. At risk are athletes and people of asthenic physique, who have poorly developed muscles that protect the bones of the shoulder girdle.

During a complicated birth, when the doctor has to turn the baby by the hand and help him move along the birth canal, the newborn may get dislocated. It is easily reducible, and treatment usually involves simply applying a tight bandage.

A special group of causes of dislocation include genetic disease states in which damage to bone and muscle tissue occurs. This can occur in people of different ages (from newborns to old age).

Symptoms of dislocation of the outer (acromial) end of the clavicle

With this injury to the shoulder girdle, the patient complains of pain in the area of ​​the acromion joint, and there is some limitation in the movement of the joint. Sometimes, the pain makes any attempt to move the arm impossible. Swelling always occurs at the site of injury. There is deformation of the joint. You can often see a section of bone protruding upward or backward. True, severe swelling can hide this sign.

A specific symptom of dislocation of the acromial end of the clavicle is the so-called “key effect”. When you press on the protruding end of the collarbone, it falls into place, but when the pressure stops, it again begins to protrude unnaturally above the surface. This is how they determine whether a clavicle has been dislocated or fractured.

When palpating the injured area, a local increase in temperature is felt and pain symptoms intensify. If soft tissue damage occurs, a hematoma may form.

First aid

When providing first aid to a victim who has suffered a dislocated collarbone, it is first necessary to ensure fixation and rest of the injured limb. This can be done using a bandage or cloth scarf. The arm is suspended in a bent state, and a small soft cushion is placed in the armpit.

Since the injury is very painful, you can apply a cold compress to the sore spot. The ice must be wrapped in a cloth to prevent the skin from frostbite. Such a compress can be applied for no more than a quarter of an hour with an interval of half an hour between procedures.

It is important to know! Attempting to straighten a dislocation on your own is strictly prohibited, since inexperienced actions can lead to negative consequences. Also, before the ambulance arrives, you should not give the patient strong painkillers, which can change the clinical picture.

Diagnosis of clavicle dislocation

Dislocation is diagnosed quite easily by obvious external signs and interviewing the patient. To clarify the diagnosis, to identify damage to blood vessels, nerve endings and nearby tissues, an X-ray examination is prescribed.

If the doctor has additional questions and doubts about the diagnosis, a computed tomography scan is prescribed. This study allows you to examine the injured area layer by layer.

Only after a detailed study of the images does the doctor make a final diagnosis and prescribe appropriate treatment.

Treatment

Treatment of dislocation of the acromial end of the clavicle can occur in two ways: conservative and surgical. But first you need to realign the displaced bone. This procedure is performed by laying the patient on a flat surface and placing a soft cushion (for example, from a rolled up towel) under the joint. Local anesthesia is used to relieve pain. The limb is stretched along the axis and at the same time the traumatologist presses on the collarbone, returning it to its place.

Conservative method

The reduced limb must be well fixed so that the damage heals. With the conservative method of treatment, inelastic or elastic bandages are used for these purposes.

The most common is a non-elastic plaster cast. In this case, various types of plaster casts are applied, supplemented with pelot - a soft insert that presses on the acromial joint, fixing it.

Elastic bandages have increasingly begun to be used in the treatment of dislocations recently. The Deso bandage, a thoracobronchial bandage made with an elastic bandage, copes well with the task. But, just as in the case of plaster, it is necessary to use a pelot and a cotton roll placed in the armpit. In cases of subluxation of the acromial dislocation of the clavicle, a McConnell bandage can be used when the bones are fixed with an adhesive plaster.

With a conservative approach to the treatment of dislocation, the limb is immobilized for a period of 4-6 weeks, followed by rehabilitation.

Surgery

In cases where conservative treatment was ineffective, and in cases of old injuries, the patient is sent to the hospital and the dislocated end of the clavicle undergoes surgery. In its process, torn ligaments are sutured and parts of the damaged joint are fixed in various ways.

The most common surgical treatment methods are as follows.

1. Fixation of bones with knitting needles. This method is somewhat outdated and less effective. When using it, cases of relapse are frequent.
2. Fixation with screws. The method is more reliable, but leads to limitation of limb movements during use. Relapses are much less common.
3. Sewing buttons. The method incorporates the main points of the first two. There is no restriction of movement in the joint, but marks (scars) remain from the use of buttons. Relapses also happen.
4. Ligament plastic surgery. This method is the most effective. The injured or torn ligament is replaced with an artificial one.

After using any of the described methods of surgical treatment of dislocation of the acromial clavicular joint, fixation with plaster is performed for a period of one and a half months.

The choice of method and material used is selected individually by the attending physician, taking into account the characteristics of the patient’s body and the severity of the injury.

Treatment of injury with folk remedies

Traditional medicine is rich in recipes that relieve many diseases. There are also a number of time-tested remedies for the treatment of dislocations. They help relieve swelling, reduce pain, and promote healing of damaged ligaments. But all of them can be used only after the bone has been set. Let's list just a few of them.

1. The dough is mixed with vinegar and applied to the injury site. This helps reduce pain symptoms.
2. A paste is prepared from freshly picked wormwood leaves and applied to the shoulder for about thirty minutes.
3. A gauze swab is dipped in warm milk, squeezed out a little, applied to the sore spot and wrapped in something warm.
4. A paste is prepared from ordinary onions (fresh or fried) and mixed with sugar in a ratio of 1:10, and the resulting product is applied to the site of the dislocation, bandaging it. The lotion needs to be changed every 5-6 hours.
5. Elecampane has been known since ancient times for its healing properties. An infusion prepared from the root of this plant is used for lotions. Helps promote rapid healing of ligaments.

Important! Treatment of dislocation with folk remedies can be carried out only after consultation with your doctor.

Rehabilitation after a dislocated collarbone

Regardless of the method used to treat the dislocation of the external (acromial) end of the clavicle, after a long period when the limb was immobilized, rehabilitation procedures are required. They are necessary to return the injured arm to its pre-injury level.

Patients with such injuries undergo a complex of physiotherapy, massage and physical therapy. Physiotherapy helps normalize metabolism and accelerate the healing process. But they are contraindicated for people who have metal structures in their bodies (for example, knitting needles).

Massage has no contraindications for use. It promotes the process of lymph outflow from the damaged joint, improves blood circulation, and develops atrophied muscles after a period of immobilization.

From the second day after the joint reduction procedure, therapeutic exercises are prescribed to restore motor activity. Exercises for dislocation of the acromial end of the clavicle are performed first with a small amplitude, gradually increasing the load on the injured arm.

All exercises are combined with breathing exercises, which are necessary to relieve tension from individual muscle groups. It is recommended to use various sticks, dumbbells, and balls. Good results come from exercises performed in water (in a pool or bath).

It is important to pay attention to the quality of nutrition during the rehabilitation period. The body must receive all the necessary vitamins and microelements. Calcium and collagen are especially needed to restore joint tissue.

The rehabilitation process, depending on the severity of the injury, can take from one and a half to three months. With strict adherence to all recommendations of specialists, performance is fully restored.

No one is immune from injuries in life, but timely consultation with a doctor and initiation of proper treatment will minimize the time of illness and prevent negative consequences.

In medicine, injury to the sternoclavicular joint is rarely observed. Of the total number of similar injuries, such damage accounts for 5%. Due to the anatomical location of the joint, clavicle dislocation is classified as a dangerous injury.

Such damage occurs as a result of mechanical impact, road traffic accidents, pathological changes in bone tissue, and in athletes.

The clavicle is a small S-shaped bone, consisting of a body and two terminal segments - the sternal (sternal) and acromial. The sternal end is convex and articulates with the sternum by the costoclavicular ligament, the acromial end is concave and is connected by the coracoclavicular to the acromion of the scapula. The process of ossification of this bone begins during intrauterine development at the 6th week. The subclavian muscle is attached to the posterior lower surface of the bone.

The clavicle bone performs protective, supporting and motor functions and connects the arm to the skeleton.

Due to the anatomical structure and many functions that the clavicular bone performs, its displacement and damage to the clavicular joint are considered particularly severe in traumatology.

Dislocation of the clavicle is differentiated depending on the type of injury to the capsular-ligamentous apparatus into:

• External- dislocation of the acromial end of the clavicle. The acromial end of the bone articulates with the scapula through two ligaments. Injuries are divided into subluxation (damage to the coracoclavicular or acromioclavicular ligament) and complete (the entire ligamentous joint is injured).
• Interior– dislocation of the sternal end of the clavicle. There are anterior, supra- and posterior sternal displacements. Cases of prosternal one are recorded more than others.

Acromial dislocations may be accompanied by significant displacement of the end of the clavicular bone:

• The end of the joint moves backward and injures the trapezius muscle.
• The acromial bone fragment has a superior displacement. A distance appears (2-3 times greater than usual) between the clavicular end and the coracoid process of the scapula.
• The acromial end moves down under the scapula and remains motionless in this position.

Dislocation of the sternal end of the clavicle (sternal) - may be accompanied by damage to the vessels and nerves of the shoulder girdle.

Note!

The displacement of this bone has a characteristic feature - the “key effect”. The displaced part of the bone is reduced when pressure is applied, but after the pressure stops, it pops back out. This is the difference between a dislocation and.

A displacement of the clavicular bone is considered old if several weeks (more than 2) have passed since the injury. Incomplete - occurs without obvious signs, with the exception of a violation of the anatomical structure of the acromioclavicular joint.

Note!

Old injuries can only be treated surgically.

Trauma code according to ICD 10

According to the international classification of diseases ICD 10, damage to the sternoclavicular joint is included in the class “Dislocation, sprain and overstrain of the capsular-ligamentous apparatus of the shoulder girdle S43”.

Causes

Falls, direct forceful blows to the joint area, and road traffic accidents can cause a dislocated collarbone. This type of injury is typical for athletes and people leading an active lifestyle.

Displacement of the collarbone in a newborn during childbirth occurs during severe or rapid labor. The acromial end of the bone is mainly injured. A dislocation of the clavicle in an infant, due to the structure of the bones, can be easily eliminated and immobilization of the joint is not necessary.

Injuries to the sternoclavicular joint can cause acromioclavicular arthrosis.

Symptoms

When a clavicle is dislocated, the following symptoms occur:

• Pain in the area of ​​injury:
• A violation of the anatomical structure is visually noticeable;
• When you move your hand, the pain increases;
• The mobility of the sore shoulder decreases;
• If the nerves are damaged, numbness and paralysis of the limb are possible;
• Edema;
• Bruise.

Symptoms are supplemented by certain signs that depend on the area of ​​damage.

With an acromial injury, the patient presses the arm against the body. Pain sensations are concentrated in the acromioclavicular joint, and the motor function of the shoulder joint decreases. Prosternal - characterized by protrusion of the inner end of the joint forward, pectoral - forward and upward, metasternal - retraction.

The main sign of bone displacement is the “keyboard symptom.”

First aid

If you suspect that the clavicular joint is damaged, first of all it is necessary to immobilize the injured arm (hang the arm using a bandage or bandage thrown over the neck). A cushion is placed in the armpit. To reduce pain and swelling, apply a cold compress to the injured area.

Carrying out the manipulation of reversing a dislocated clavicle on your own, unless you have special qualifications, should not be done.

What to do if your collarbone is dislocated

What to do if your collarbone is dislocated? The first thing to do in case of any injury is to call an ambulance. If the patient’s symptoms indicate a closed dislocation of the acromial end of the clavicle, the injured arm must be immobilized. To do this, a bandage is made using a scarf or bandage, which is thrown over the neck, the hand is placed in the “loop” of the bandage in a bent position (90°). To reduce swelling, cold packs are applied to the sore shoulder. Such injuries are usually accompanied by severe pain. But giving painkillers is not recommended. They can obscure symptoms and make diagnosis difficult. You can take the patient to the hospital yourself.

Diagnostics

A dislocation of the clavicle is diagnosed based on an initial examination of the patient (a displaced bone fragment is visually visible), palpation, and anterior and posterior radiographs. X-rays can determine the type of sternoclavicular joint dislocation and exclude or confirm possible other injuries.

If internal damage is suspected, an MRI is performed.

Treatment

Treatment for a dislocated clavicle begins after determining the type of injury. In case of partial or complete rupture of the acromioclavicular ligament, without other damage, conservative treatment is prescribed. A closed reduction is performed in the acromial area and the injured arm is fixed with a bandage for 14–28 days. A clavicular orthosis may be used for immobilization. The device presses on the acromial end of the clavicle, fixing the anatomically correct position.

If the clavicle is dislocated, kinesiotaping of the joint can also be performed. Kinesiology tape is applied in a hospital.

Note!

Kinesio taping is a method aimed at restoring the body naturally.

Taping has a positive effect on:

• nervous;
• blood circulation;
• lymphotic;
• muscular system.

To reduce pain and swelling in the first days, apply cold compresses and use painkillers. Physical therapy is started taking into account the pain syndrome. They start with isometric exercises, then move on to isotonic exercises. Athletes are advised to return to normal training when the joint is completely healed (no pain on palpation or stretching of the limb).

Reducing a dislocated clavicle is a fairly easy manipulation; it is more difficult to fix and hold the end of the bone in the correct position.

Note!

The most optimal method is to apply plaster when treating this type of damage using a non-invasive method.

After immobilization of the joint, treatment can be continued at home.

Treatment of complete dislocations can be either conservative or surgical.

Other types of injuries require surgical intervention: the clavicular joint is fixed from the inside and the coracoclavicular ligament is sutured.

Surgical treatment

Surgical treatment is prescribed in complicated and chronic cases of clavicle dislocation. Closed reduction is carried out before surgery, and during surgery the clavicular bone is fixed with knitting needles, screws, plates, “buttons”, etc.

When immobilizing the joint with wires, relapse may occur, since the rupture of the ligament articulating the outer fragment of the clavicle is not restored.

Fixation using screws limits and reduces bone movement. Which leads to upper limb dysfunction.

Fixation with buttons has a more positive prognosis for restoration of hand function. Relapses are possible.

Ligament plastic surgery is considered the most effective operation for the treatment of clavicle dislocation. To restore torn ligaments, lavsanoplasty is used.

A type of plastic surgery used for displacement of the acromial end of the clavicle, including reposition and fixation of the acromial end, formation of vertical canals in the bone and acromion of the scapula using Mylar tape.

This method of invasive treatment is the most effective:

• Reliability of fixation of the articular ends of the acromial clavicular joint ;
• The morbidity of the operation is low;
• Low probability of postoperative complications.

After surgery, the joint is immobilized with a plaster cast for 6 to 8 weeks.

After treatment, dislocation of the sternal end of the clavicle can lead a normal life in 1.5-2 months.

Rehabilitation

Rehabilitation after a dislocated collarbone includes:

• exercises (physical therapy) that restore joint function. Full load on the sternoclavicular joint is allowed 8-12 months after injury.
• Massage.
• Physiotherapeutic procedures.
• Preparations containing calcium and collagen, etc.

Restoring performance after a dislocated collarbone depends on the individual characteristics of the body, the degree of damage received, the rehabilitation measures taken, etc.

Physiotherapy

During the rehabilitation period, physiotherapeutic procedures are prescribed to help restore the clavicular joint.

Rehabilitation measures include physiotherapeutic procedures:

• Electrophoresis
• Massage
• Manual therapy.

Rehabilitation of complex cases takes more than 8 weeks.

Complications and consequences

Invasive intervention for injury to the sternoclavicular joint can lead to complications:

• Bone fracture due to strong pressure;
• Incomplete reduction;
• Wound infection;
• The emergence of a pathological process – arthrosis of the acromioclavicular joint.
• Sharp pain in the suture area.
• Formation of growths on the acromial fragment of bone tissue.
• Dysfunction of upper limb mobility.

With timely treatment and receipt of qualified assistance, following all the doctor’s recommendations, patients diagnosed with a dislocated clavicle experience a rapid recovery of the damaged joint.

Dear readers of the 1MedHelp website, if you still have questions on this topic, we will be happy to answer them. Leave your reviews, comments, share stories of how you experienced a similar trauma and successfully dealt with the consequences! Your life experience may be useful to other readers.

Author of the article:| Orthopedic doctor Education: Diploma in General Medicine received in 2001 from the Medical Academy named after. I. M. Sechenov. In 2003, she completed postgraduate studies in the specialty “Traumatology and Orthopedics” at the City Clinical Hospital No. 29 named after. N.E. Bauman.