POCUS Of Sternoclavicular Joint To Assess Dislocation
Maria Pia Gauci (ENP), Dr. Himanshu Gul Mirani (ED Consultant)
Nottingham University Hospitals, NHS Trust
Case Presentation:
A 56-year-old female presented to the emergency department with complaints of painful swelling and
bruising around the left sternoclavicular joint following an injury while playing rugby.
o There was localised fullness obliterating part of
supraclavicular fossa compared to the right side.
o On presentation she was haemodynamically
stable with no airway compromise, no
circulatory or neurological deficit.
o Speech clear and swallow normal.
o Neck full range of movement
Case History:
Posterior dislocation of the sternoclavicular joint is a life-threatening emergency since it can be associated
with injuries to several important mediastinal structures like the subclavian vessels, trachea, and oesophagus (1). It warrants an emergency reduction.
POCUS Of Sternoclavicular Joint To Assess Dislocation
Management and Outcome:
Case was discussed with radiology department and given her reassuring clinical finding and POCUS
assessment, she was discharged with safety netting advise.
Investigation:
Xray of the chest was suspicious for asymmetric alignment of the left SCJ, although the film looked
slightly rotated. POCUS examination revealed normal alignment of the left SCJ. It also confirmed a hematoma in the muscle belly of the sternocleidomastoid muscle on the left compared to the right side.
Key Learnings and Points:
X-rays, like the serendipity views can be difficult to interpret, particularly due to rotation and overlapping
structures.
POCUS has been documented to be a very useful modality that helps to rapidly screen for this injury (2).
In this case POCUS also picked up on an alternative diagnosis of sternocleidomastoid hematoma. It’s a
very rare condition to occur post blunt trauma. It is usually managed conservatively unless there are
complications from its expansion.