Superior Sternoclavicular Dislocation Treated with Costoclavicular Ligament Reconstruction Using Autograft: A Case Report.

Case: We describe a case of a traumatic superior dislocation of the sternoclavicular joint (SCJ) due to an isolated rupture of the costoclavicular ligament (CCL). A magnetic resonance imaging (MRI) scan demonstrated the CCL rupture with preservation of the anterior and posterior SCJ ligaments. This was successfully treated with an isolated hamstring tendon reconstruction of the CCL, resulting in a satisfactory outcome at 1 year after the procedure.

The incidence of medial end clavicle fractures is higher than had previously been considered.

Background: Previous X-ray epidemiological studies have estimated the incidence of medial end clavicle fractures to account for 2-3% of all clavicle fractures.

Materials And Methods: At our institution X-rays of every patient attending the Emergency Department are reviewed at a Virtual Fracture Clinic by a Consultant Orthopaedic Surgeon. Patients with a fracture are referred to the Shoulder and Elbow Fracture Clinic.

Current concepts in anterior glenohumeral instability: diagnosis and treatment.

The glenohumeral joint is the most dislocated articulation, accounting for more than 50% of all joint dislocations. The reason behind shoulder instability should be investigated in detail for successful management, and the treatment plan should be individualized for all patients. Several classification systems have been proposed for glenohumeral instability.

Management of Vertical Sternal Fracture Nonunion in Elite-Level Athletes.

Background: Sternal fractures are rare, and they can be treated nonoperatively. Vertical sternal fractures have rarely been reported.

Purpose: To describe the management and surgical treatment of a series of elite-level athletes who presented with symptomatic nonunions of a vertical sternal fracture.

Revision guided suture-button bone block stabilization of the shoulder in the presence of significant retained glenoid metalwork.

Aim: Positioning and fixation of the bone block during revision anterior stabilization of the shoulder, in the presence of significant retained glenoid metalwork, can be challenging. We present the results of a series of patients who underwent a revision bone block procedure secured with double suture buttons using a drill guide system, the position of which was calculated from a preoperative computed tomography (CT) scan.

Materials And Methods: We undertook a revision bone block stabilization of the shoulder, using a guided double suture-button fixation, in 10 patients with significant retained glenoid metalwork from previous procedures.

Prognosis After Arthroscopic Superior Medial Scapuloplasty for Snapping Scapula Syndrome Improves After a Transient Beneficial Response With an Ultrasound-Guided Subscapular Cortisone Injection.

Purpose: To evaluate the prognostic value of an ultrasound-guided subscapular local anesthetic and cortisone injection in a consecutive series of patients who underwent an arthroscopic superior medial scapuloplasty for snapping scapula syndrome (SSS) and had been refractory to conservative treatment.

Methods: We undertook an arthroscopic superior medial scapuloplasty on patients with a clinical diagnosis of SSS who had failed a structured physiotherapy program and had either gained a good response or no to minimal response to preoperative ultrasound-guided subscapular local anesthetic and cortisone injection. The patients were assessed preoperatively and at final follow-up with the QuickDASH and Constant scores, and their pain was assessed with a visual analog scale (VAS).

Recurrent acromioclavicular joint dislocation with an associated coracoid fracture following acromioclavicular joint reconstruction.

Acromioclavicular joint injuries are common and account for up to 12% of all shoulder girdle injuries and have been reported as being as high as 50% in sports-related shoulder injuries. While the majority of acromioclavicular joint dislocations can be treated non-operatively, there are certain injury configurations, which can include high-grade dislocations in overhead athletes, where surgery may be indicated. The surgical management of acromioclavicular joint instability has moved towards recreating the action of the coracoclavicular ligaments by resuspending the clavicle on to the coracoid.

Arthroscopic Excision Arthroplasty of the Sternoclavicular Joint for Osteoarthritis: A Case Series of 50 Patients.

Purpose: to report the results of a consecutive series of 50 patients who underwent an arthroscopic excision of the sternoclavicular joint (SCJ) for primary osteoarthritis refractory to conservative treatment.

Methods: We undertook an arthroscopic excision of the SCJ in 50 patients with primary osteoarthritis refractory to conservative treatment. This included an adequate course of physiotherapy and at least 1 ultrasound-guided cortisone injection.

Osteochondritis dissecans with associated secondary chondromatosis in an adolescent shoulder.

Osteochondritis dissecans (OCD) of the humeral head is rare and usually occurs in adolescents. Secondary synovial chondromatosis occasionally occurs in the shoulder but has only been reported twice in an adolescent. We describe the case and management of an adolescent male who presented with features of OCD and secondary chondromatosis in his shoulder occurring simultaneously.

Digital tomography is an effective investigation for sternoclavicular joint pathology.

Objective: Plain radiographs of the sternoclavicular joint (SCJ) are difficult to interpret, and a CT or MRI scan is the usual investigation of choice. At our hospital, we use digital SCJ tomograms as our first-line investigation for all SCJ pathologies. We wanted to ascertain whether this is a safe and appropriate first-line imaging investigation.

Arthroscopic All-Intra-articular Revision Eden-Hybinette Procedure for Recurrent Instability After Coracoid Transfer.

Failure, in the form of recurrent shoulder instability, following a coracoid transfer procedure presents a challenging problem. Successful treatment with a revision Eden-Hybinette procedure, by both an open and arthroscopic approach using screws to secure the bone graft, has previously been reported. However, both the open and arthroscopic approach have required careful dissection through the distorted soft-tissue anatomy in the anterior compartment in front of subscapularis to gain access to the front of the glenoid through a muscle split.

Displaced medial end clavicular fractures treated with an inverted distal clavicle plate contoured through 90 degrees.

Background: This study assessed whether treating medial end clavicular fractures using an inverted distal clavicle locking plate, twisted through 90° around its axis, would allow for a less invasive surgical approach and improve screw trajectory insertion.

Materials And Methods: We searched the databases of the 2 senior authors for patients who had sustained an acute, displaced fracture of the medial end of the clavicle and had undergone operative fixation using an inverted distal clavicle plate contoured through 90°. Through an inferior incision, a contoured locking plate was positioned on the anterior surface of the medial end of the clavicle.

Cerebrovascular assessment of patients undergoing shoulder surgery in beach chair position using a multiparameter transcranial Doppler approach.

Although the beach-chair position (BCP) is widely used during shoulder surgery, it has been reported to associate with a reduction in cerebral blood flow, oxygenation, and risk of brain ischaemia. We assessed cerebral haemodynamics using a multiparameter transcranial Doppler-derived approach in patients undergoing shoulder surgery. 23 anaesthetised patients (propofol (2 mg/kg)) without history of neurologic pathology undergoing elective shoulder surgery were included.

Swellings of the sternoclavicular joint: review of traumatic and non-traumatic pathologies.

The sternoclavicular joint (SCJ) is an integral part of the shoulder girdle that connects the upper limb to the axial skeleton.Swelling of the SCJ is commonly due to trauma, degeneration, infections and other disease processes that affect synovial joints.This review also focuses on uncommon conditions that could affect the SCJ, including SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome, Friedrich's disease and Tietze syndrome.

Treatment of First-Time Traumatic Anterior Dislocation of the Sternoclavicular Joint With Surgical Repair of the Anterior Capsule Augmented With Internal Bracing.

Background: Traumatic anterior dislocations of the sternoclavicular joint (SCJ) are rare. Although they can usually be treated by a closed reduction, the reported subsequent recurrence rate is 50%.

Purpose: To determine whether further instability after first-time traumatic anterior dislocation would be prevented by a minimally invasive open repair of the anterior SCJ capsule, augmented with internal bracing.

Arthroscopic Excision of the Sternoclavicular Joint.

Osteoarthritis changes at the sternoclavicular joint (SCJ) have been shown to be present on computed tomography in more than 90% of people over the age of 60 years. Although usually asymptomatic, when symptoms do occur, they can be very debilitating. Most patients respond favorably to conservative treatment, but there is a small cohort of patients who continue to be symptomatic despite adequate conservative treatment.

Increased wound complication with intramedullary screw fixation of clavicle fractures: Is it thermal necrosis?

Purpose: Adult mid-shaft clavicle fractures are common injuries. For displaced fractures, open reduction with plate or intramedullary (IM) fixation is the widely used techniques. All methods have their own potential drawbacks, especially related to local soft tissue complications.

Arthroscopic Sternoclavicular Joint Diskectomy for Acute and Chronic Tears.

Purpose: To describe the results and functional scores in a group of patients who underwent arthroscopic excision of a symptomatic sternoclavicular joint (SCJ) disk tear with a minimum follow-up period of 2 years.

Methods: Between April 2010 and December 2014, 14 patients underwent arthroscopic excision of a torn SCJ disk. Patients whose intended surgery was an isolated diskectomy and underwent that surgery only, with no additional procedure, were included.

Arthroscopic Intra-articular Disk Excision of the Sternoclavicular Joint.

The sternoclavicular joint (SCJ) has a complete intra-articular disk that can be damaged either as a result of trauma or as part of ongoing degenerative joint disease. Although often asymptomatic, SCJ disk tears may lead to mechanical symptoms and pain. Previously, isolated symptomatic SCJ disk tears have only occasionally been mentioned in the literature with a few associated case reports of diskectomy by open arthrotomy.

Sternoclavicular joint osteophytosis: a difficult diagnosis to swallow.

Unexplained dysphagia requires prompt investigation to rule out a possible underlying malignancy. We describe the case of a 60-year-old man who presented to his family practitioner with a 1-year history of increasing dysphagia with associated pain over the front of his chest. He was referred on to an ear, nose and throat specialist where no obvious laryngeal pathology was found at direct laryngoscopy, but an 'indentation' of the right anterior larynx, which increased with external pressure on the sternoclavicular joint (SCJ), was noted.

Surgical treatment of a concurrent type 5 acromioclavicular joint dislocation and a failed anterior glenohumeral joint stabilization.

Traumatic glenohumeral joint dislocation and acromioclavicular joint subluxations tend to occur in young active males. Use of the coracoid process either as a transfer in recurrent instability or in suspensory reconstructions of the coracoclavicular ligaments have gained popularity. However this requires careful consideration in the event of concomitant injuries if they both require surgery.