Sternoclavicular Joint Injury

[bluejaykaren]

My 14 year old daughter has an unstable SC joint separation. It did not show up on an x-ray when it happened and her doctor just let it go so by the time she saw the orthopedic it had been too long since the injury for it to be reset. It moves in and out of joint when she moves her shoulder. He ordered a ct scan and said he will discuss options after looking at it but he said that she will likely just have to live with it or they could remove the end of the bone to relieve pain if have too. He is not a diver so I wanted to ask what that means for her diving future. She is AOW and planned on rescue cert this summer. She will be devastated if she can't dive anymore. The doc isn't a diver. Should I take her bc to him so he can see what wearing it would do to her shoulder? She does have the zeigle zena which zips up instead of a sternum strap and in the water she doesn't need the shoulder straps tight. I would appreciate any help or suggestions.

 

[DocVikingo]

Hi blujaykaren,

Not enough information yet to make educated suggestions regarding return to scuba.

For example, it is not clear if we are talking an unreduced anterior or posterior dislocation (or something else). With anterior dislocation, which I am guessing is the case here, there commonly is a hard (and painful) bump in the center of the chest caused by forward jutting of the clavicle. Such a protrusion is much less commonly seen with the usually much more serious posterior dislocation & the latter may be associated with difficulty breathing & a feeling of choking/trouble swallowing/having a tight feeling in the throat.

Surgical correction of sternoclavicular joint separations, particularly posterior dislocation, entails some risk as the area behind the sternum contains organs like the heart & its large vessels, trachea, esophagus, etc. As such, in appropriate cases a series of rehab exercises may be tried first.

Until the orthopedist sorts out the imaging findings, it would be prudent to avoid scuba. The movements involved in donning & doffing gear are simply inviting pain & possibly worse.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

 

[Mike2Fst]

Doc Vikingo's response is excellent. To take this one step further, the diving concerns also branch out to hiking with backpacks, lifting objects on affected side and we all know about those large heavy purses that women carry, the 55 gallon sized ones. I've worked with a few patients who have had the proximal end of the clavicle removed do to chronic dislocation. With appropriate post surgical physical therapy and allowing for healing, she should have no problem taking up diving or toting around one of those heavy purses when she hits that fashion stage. With the removal of the proximal end of the clavicle, other soft tissues will now be responsible for static and dynamic load bearing in which the SC joint had a part prior to the surgery. Hope this helps.

Michael Skovgaard, PT

 

[bluejaykaren]

Thanks so much to you both. You have really helped. It is anterior. The doctor did mention removing the end of the clavicle if it stays a chronic probelm. She compares the feeling like when you snap a lid on and off a medicine bottle. We will just have to wait till next week when the doc. reads the scan.

 

[DocVikingo]

My pleasure, bjk.

Anterior dislocations usually don't cause serious long-term complications, but may result in cosmetic deformity & decreased range of motion.

Using the affected arm/shoulder for lifting & for reaching overhead can be awkward & painful initially, but this should improve with rehab. The possibility of return to scuba seems likely once treatment is completed. IMHO, the idea of taking your daughter’s BC to an appt with the orthopedist so that he can see what using it actually involves is an excellent one.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.