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Intra-articular disk ligament
2%
16/980
Anterior fasciculus of costoclavicular ligament
1%
9/980
Posterior fasciculus of costoclavicular ligament
22/980
Anterior sternoclavicular ligament
14%
141/980
Posterior sternoclavicular ligament
80%
781/980
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The posterior sternoclavicular (SC) ligament is the primary restraint to anterior/posterior instability at the SC joint (Answer 5).Dislocations of the SC joint are rare and usually the result of significant trauma to the shoulder or chest. The sternoclavicular joint itself is a diarthrodial saddle joint that relies on the surrounding ligament complex for stability. With injury to these ligaments, dislocation may occur anteriorly or posteriorly. Anterior dislocation is far more common and may be identified based on location of pain and prominence on exam. Posterior dislocation may cause compression on the mediastinal structures, causing dyspnea, dysphagia, or vascular compromise. Traumatic dislocations should be reduced under anesthesia, particularly those with posterior displacement. The need for vascular backup is controversial but still recommended as injury to the vessels during reduction could cause rapid exsanguination. Groh and Wirth published a JAAOS article with an overview of traumatic SC joint injuries, noting they are relatively rare overall but may be life-threatening. While anterior dislocations are much more common, posterior dislocations can be associated with serious complications like dyspnea, dysphagia, and extremity swelling. A CT scan is recommended as radiographs make it difficult to come to a conclusive diagnosis. Sewell et al. looked a current concepts in instability of the SC joint. They mention that injury to the SC joint can come in the form of anterior/posterior dislocation of medial physeal separation. Proper recognition of these injuries is important, with many being amenable to nonoperative management but a select few (primary posterior) requiring more urgent surgical attention. Figure A is an axial CT scan of the chest demonstrating posterior displacement of the clavicle at the left SC joint. Incorrect Answers:Answer 1: The intra-articular disk ligament prevents medial and superior displacement of the clavicle.Answer 2: The anterior fasciculus of the costoclavicular ligament resists superior rotation and lateral displacement of the SC joint. Answer 3: The posterior fasciculus of the costoclavicular ligament resists inferior rotation and medial displacement of the SC joint. Answer 4: The anterior sternoclavicular ligament is the primary restraint to superior displacement of the medial clavicle.
4.3
(4)
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