Dislocation of the collarbone

The clavicle is a small bone that connects the shoulder to the sternum, stabilizing the movement of the arm. Sudden movements, contact sports, unsuccessful falls on an outstretched arm provoke a dislocation of the collarbone. In this situation, the bone is displaced from the joint either from the side of the sternum or in the shoulder region (where it connects to the upper end of the scapular bone), there is a sharp pain that becomes stronger if the person tries to move the arm or lift it. Similar symptoms are possible with a fracture, injuries of other bones in this area, so it is important to contact a traumatologist who will make the correct diagnosis and determine the tactics of treatment.

Dislocation of the collarbone: how can it happen?

Often, dislocation of the collarbone occurs in adolescents and young men who play football, handball or volleyball, extreme sports (auto, motorcycle racing, rock climbing, parkour), contact (wrestlers, boxers, judoists), lift heavy objects. A dislocation of the collarbone is possible if there is a fall on the arm or back, with blows to the shoulder, when the greatest force falls on the region of the scapula, shoulder joint or the collarbone itself.

A special variant of dislocation of the clavicle occurs in newborns, during complicated, rapid childbirth.

According to trauma departments, this injury occurs in 5-12% of cases of all dislocations. There are two types of dislocation of the collarbone:

• sternoclavicular, if that part of the bone that is adjacent to the sternum is displaced from its place;
• acromioclavicular, if the integrity of the joint connecting the scapula (due to the acromial process of the bone) with the clavicle is violated.

Damage in the area of ​​the shoulder and the process of the scapula occurs 4-5 times more often, since this part of the body is more mobile. Often, injury occurs if a person falls, reflexively moving his arm away and trying to slow down the movement of the body. Symptoms of dislocation are possible if a sharp direct blow falls on the junction of the clavicle, with a sharp transverse compression of the zone of the scapula, sternum and the clavicle itself.

Direct injury most often provokes dislocation of the acromial joint. Indirect damage, if adjacent tissues are injured, leads to the exit of the clavicle from its rightful place in the sternum.

The clavicular joints are quite strong, inactive, strengthened by powerful ligaments. Therefore, rather powerful injuries lead to dislocations. Along with the displacement of the clavicle, ligament rupture occurs. If only one ligament is torn, incomplete dislocation is determined (doctors call it subluxation), if two ligaments with the capsule surrounding them are damaged, this is a complete dislocation.

A clavicle injury is considered fresh if a doctor examines and detects a dislocation within 3 days of the injury. In the period from 3 days to 3 weeks – this is a stale dislocation. When damage is detected after 3-4 weeks or even later, these are chronic dislocations. It is much more difficult to treat them, as the tissues gradually change, adjusting to the new position of the collarbone.

Symptoms of a dislocated collarbone

Symptoms that occur after a dislocation of the collarbone vary depending on the nature of the injury – whether the acromial (shoulder) end of the clavicle or the sternal end is affected.

acromioclaviculardislocation manifested by a sharp pain at the site of injury, severe swelling of the tissues under the skin. The edge of the clavicle protrudes upward and towards the back, any touch to this place is painful, because of this, hand movements are limited. A special “symptom of the key” may appear – if you press on the protruding end of the collarbone, it temporarily falls into place, and if you remove your finger, it sticks again. If one ligament is injured (incomplete dislocation) – the edge of the collarbone does not stick out much. If the injured arm is pulled down, the shoulder moves, and the collarbone also sticks out. With a complete dislocation, the edge of the clavicle is very noticeable, slight pulling of the arm leads to an even greater protrusion of the edge of the clavicle.

Sternoclavicular dislocation – this is, first of all, pain in the upper part of the sternum, a strong swelling of the tissues. If the clavicle is dislocated forward, a tubercle appears under the skin, if the clavicle is dislocated backward, the skin over the joint is noticeable, there may be a feeling of shortness of breath or pain with a deep breath. If this is a suprasternal dislocation, the edge of the clavicle protrudes above the upper edge of the sternum.

Chronic dislocation of the clavicle is usually incomplete, and then there are practically no complaints of pain and swelling. A person can only note the deformation of tissues in the area of ​​​​the shoulder or sternum. If this is a complete chronic dislocation, there may be periodic pain at the site of bone displacement and a decrease in muscle strength in the arm.

Treatment of dislocation of the collarbone

In order to properly treat an injury in the clavicle area, an accurate diagnosis is needed to determine the type of dislocation and its localization (sternal or scapular part of the clavicle).

Diagnostics

An experienced traumatologist can make a diagnosis immediately, after examining the patient and clarifying the method of injury (fall, blow to the shoulder, accident). When examining, the doctor notes changes in the area of ​​​​the shoulder girdle, swelling and the protruding edge of the collarbone, gently probes the damaged area, noting where the pain is most pronounced and whether there is a distance between the collarbone and the sternum or scapula.

Radiography helps to confirm the diagnosis and clarify the type of dislocation. If this is an incomplete dislocation, the doctor compares the collarbones from the affected and healthy side, in some cases, before taking the picture, the patient is given a small weight in the arm so that the shoulder drops. In this case, the deviation of the clavicle will be more noticeable.

Modern treatments

We asked questions about the tactics of treatment of dislocations of the clavicle orthopedist Maxim Kolinsky.

Indications for surgical treatment, i.e. open reduction of dislocation, sternal end of the clavicle with joint fixation and ligament suturing are strictly limited. The operation is performed only for athletes or young people leading an active lifestyle. In case of damage to the acromioclavicular joint, if only the acromioclavicular ligament is affected, and, therefore, there is no complete dislocation of the clavicle, conservative treatment is indicated.

With a complete dislocation of the acromial end of the clavicle, when not only the acromioclavicular, but also the coracoclavicular ligaments are torn, recovery is possible only in the case of surgical treatment!

The most modern and optimal method is a combination of a thread and fixation buttons installed above the clavicle and under the coracoid process. This technique is minimally invasive (intervention is minimal) and can even be performed arthroscopically, so it is easier for the patient to tolerate and has virtually no complications. In fact, it is a prosthesis of the coracoclavicular ligament. To date, this is the only way to fix the acromioclavicular ligament that does not violate the biomechanics of the movement of the clavicle, which significantly speeds up the recovery time.

In the case of conservative treatment and in the early postoperative period, it is better to use modern orthopedic orthoses and bandages for the shoulder joint for immobilization, rather than bulky and uncomfortable plaster casts. An alternative and quite convenient, inexpensive method is the use of teip bandages.

Prevention of dislocation of the clavicle

The main method of prevention of dislocation of the clavicle is the prevention of injuries in sports and at home, in various hazardous industries. If you fall and experience pain in the shoulder or near the sternum, you should immediately seek help from a doctor.

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