A 14-Year-Old Wrestler with Shoulder Pain After a Match

Differential Diagnosis

• Acromioclavicular (AC) sprain
• Clavicle fracture
• Sternoclavicular dislocation
• Scapula fracture

Diagnosis

The correct diagnosis is anterior sternoclavicular dislocation. Note the discordance between the left and right sternoclavicular junction, with the left higher than right. Elevation of symptomatic side suggests an anterior dislocation; depressed appearance of symptomatic side suggests posterior dislocation.

Learnings/What to Look for

• Plain radiographs may be suggestive but are not sufficient for diagnosing SC dislocation
• Posterior dislocation can be associated with pneumothorax or other major organ injury to great vessels, trachea, and esophagus, etc.

Pearls for Urgent Care Management

• Any concern for a sternoclavicular dislocation requires prompt evaluation to confirm the diagnosis and to distinguish between an anterior and posterior dislocation. This is best done with contrast-enhanced CT scan
• Anterior dislocation is two to three times more common and generally requires immobilization and nonemergent closed reduction by outpatient orthopedic surgery
• Any reduction may require consultation with a cardiovascular surgeon and thorough evaluation for vascular injury

Acknowledgment: X-ray and case presented by Experity Teleradiology (www.experityhealth.com/teleradiology).