Instability and Pain: The Sternoclavicular Joint in Children

Description

Ms Alison Armstrong focuses on the management of instability and pain in the sternoclavicular joint of children, emphasizing two main conditions: atraumatic anterior instability and locked posterior dislocation, which is actually a Salter-Harris fracture dislocation. She begins by discussing the anatomy of the sternoclavicular joint, highlighting its synovial nature, the importance of ligaments, and the potential complications arising from injuries, particularly due to the proximity of vital structures such as major vessels, the trachea, and the esophagus.



Ms Armstrong explains that atraumatic instability often occurs in sporty children following minor injuries or even without clear trauma, leading to clicking and pain in the joint. Key observations include joint laxity, poor core muscle stability, and slumped postures that are common in these patients. Effective physiotherapy is emphasized, requiring a tailored approach over several months to strengthen the joint and improve function.



For traumatic presentations, particularly posterior dislocations, Ms Armstrong stresses that often these are fractures masquerading as dislocations due to the open epiphysis in children. Missed diagnoses can lead to significant complications, including thoracic outlet syndrome. The importance of using CT scans rather than traditional X-rays to detect these issues is highlighted.



The presentation concludes with surgical management strategies for both types of injuries, illustrating the operation process, typical outcomes, and successful rehabilitation results, although some patients may still experience mild symptoms. The overall message reinforces the need for careful assessment, timely intervention, and the crucial role of physiotherapy in treating sternoclavicular joint problems in children.

DOI: 10.1302/3114-251170

Specialties