I read one of your patient stories about a high school athlete with a dislocated collar bone. I also have experienced this injury and am evaluating my options for surgery. How common is a dislocated collar bone (clavicle) or sternoclavicular injury, what causes it, and what are the treatments for it?
The collarbone is also called the clavicle. Dislocations can occur at either end. Dislocation of the lateral end (outer) of the collarbone is very common – this is also known as an AC joint injury or shoulder separation. Dislocation of the medial (inner) end of the collarbone (the end near your sternum- breastbone) is fortunately a rather uncommon injury. This is called a sternoclavicular or SC dislocation.
The most common causes of a dislocation of either end of the collarbone are falls, motor vehicle accidents, or blunt force to the outer end of the clavicle.
Sternoclavicular injuries are usually treated without surgery. Many doctors are not comfortable performing surgery on these types of injuries because of the risk to the neurovascular structures that are just behind this area in the neck.
Therefore, many of these injuries become chronic and frequently they remain painful due to post-traumatic arthritis of the SC joint, from instability of the SC joint where the clavicle constantly pops in and out, or form a combination of both arthritis and instability. The decision for surgery should be left to you and your physician, although this is one injury where surgery should probably only be performed by a specialist familiar with the injury and its treatment. The best initial treatment for a dislocated clavicle is to wear a sling to take the weight from your arm off of the clavicle. If the clavicle is dislocated inward (posterior SC dislocation) surgery may be need to reduce (pull out) the clavicle to prevent it from pressing on any of the major nerves or blood vessels that run in that area. Ice can be helpful for the first 72 hours. If there are any prolonged symptoms of pain, headache, swelling in the neck, or deformity eek immediate medical attention as this is one area where prompt treatment can be very important. X-rays and a CT scan are usually needed to fully define the extent of the injury.
In chronic cases, a specialist should be seen to talk about surgical options to remove the arthritic joint, to repair or rebuild the damaged ligaments, or to perform some combination of both. For chronic instability, I prefer to rebuild the damaged ligaments of the SC joint by using a hamstring tendon from one’s leg to make new ligaments to stabilize the joint. This is an extremely technically demanding procedure but it can alleviate pain and restore stability to the SC joint.