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Cases
Shoulder Pain
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Case
This
young woman tripped down a flight of stairs and fell, landing on
her left shoulder. She complains of localized pain and swelling
over the sternoclavicular joint. Her extremities are
neurovascularly intact. What tests should be performed? What is the diagnosis?
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Scroll
down for Hint and Answer
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***** HINT *****
She is breathing comfortably but complains of pain on clavicular or arm motion.
***** ANSWER *****
Anterior sternoclavicular joint dislocation: Dislocation of the sternoclavicular
joint is rare and primarily a clinical diagnosis. Anteroposterior and cephalic
tilt radiography is indicated. The cephalic tilt view is obtained by tilting the
x-ray beam 40° in the cephalic direction. However, CT scanning is becoming the
preferred imaging modality for the evaluation of sternoclavicular injuries. In
this patient, the radiographs showed an anterior subluxation but no fracture.
Oral pain medication was given, a sling was applied, and an orthopedic surgeon
was consulted to reduce the injury with the patient under conscious sedation.
Acute posterior sternoclavicular joint dislocations are true orthopedic
emergencies. The medial end of the clavicle becomes posteriorly displaced behind
the sternum, placing pressure on the underlying trachea that can cause airway
obstruction. The patient usually has severe pain and complains of pressure on
his or her throat.
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Contributed by:
Kimberly Orlob, MD, and Heather Pyle, MD
Editor:
John Leung, MD
Editor:
David Zull, MD
Source
http://emedicine.com
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