summary Sternoclavicular Dislocations are uncommon injuries to the chest that consist of traumatic or atraumatic dislocations of the sternoclavicular joint. Diagnosis can be made with plain serendipity radiographic views. CT studies are generally required to assess for direction of displacement. Treatment is generally observation of atraumatic or chronic anterior dislocations. Closed versus open reduction is indicated for acute dislocations. Etiology Pathophysiology traumatic dislocation direction login to view 3 more bullets mechanism login to view 1 more bullet atraumatic subluxation occurs with overhead elevation of the arm affected patients are younger login to view 1 more bullet subluxation usually reduces with lowering the arm treatment is reassurance and local symptomatic treatment Anatomy Medial clavicle first bone to ossify and last physis to close (age 20-25) Sternoclavicular joint osteology diarthrodial saddle joint incongruous (~50% contact) fibrocartilage stability stability depends on ligamentous structures login to view 10 more bullets Presentation Symptoms anterior dislocation deformity with palpable bump posterior dislocations dyspnea or dysphagia tachypnea and stridor worse when supine Physical exam palpation prominence that increases with arm abduction and elevation ROM and instability decreased arm ROM neurovascular parasthesias in affected upper extremity venous congestion or diminished pulse when compared with contralateral side provocative maneuvers turning head to affected side may relieve pain Imaging Radiographs recommended views AP and serendipity views findings difficult to visualize on AP serendipity views ( beam at 40 cephalic tilt) login to view 4 more bullets CT scan study of choice axial views can visualize mediastinal structures and injuries can differentiate from physeal fractures Treatment Nonoperative reassurance and local symptomatic treatment indications login to view 2 more bullets technique login to view 2 more bullets Operative closed reduction under general anesthesia +/- thoracic surgery back-up indications login to view 2 more bullets if reduction stable login to view 4 more bullets if reduction unstable login to view 1 more bullet open reduction and soft-tissue reconstruction +/- thoracic surgery back-up indications login to view 5 more bullets presence of cardiothoracic (CT) surgery is recommended login to view 1 more bullet medial clavicle excision indications login to view 2 more bullets Techniques Closed reduction under general anesthesia reduction technique place patient supine with arm at edge of table and prep entire chest abduct and extend arm while applying axial traction and direct pressure simultaneously apply direct posterior pressure over medial clavicle manipulate medial clavicle with towel clip or fingers Open reduction and soft-tissue reconstruction approach curvilinear incision overlying medial 1/4th of clavicle, SC joint and top of manubirum care to not disrupt the SCM tendon sheath clean incision through the SCJ capsule to allow for repair at the end technique figure of 8 tendon reconstruction using 2 drill holes in the manibrium and 2 in the medial distal clavicle holes should be 1 cm apart to avoid cortical fracture gracilis or semitendinosus allograft/autograft most commonly used Medial clavicle excision approach incision made over medial clavicle resection costoclavicular ligaments must be preserved login to view 2 more bullets Complications Cosmetic deformity