Posterior Sternoclavicular Joint Dislocations in Children and Adolescents: Missed Diagnoses and Management Outcomes
Sean P Owens1, Matthew F Grady2,1
1Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Objective:
To evaluate pediatric and adolescent patients with posterior sternoclavicular (SC) joint dislocations, identify the prevalence of missed diagnoses at initial presentation, and determine injury features that may aid in earlier recognition.
Methods:
We retrospectively reviewed patients presenting to our institution with CT-confirmed posterior SC joint dislocations between October 2015 and November 2024. Anterior dislocations, subluxations, and cases without confirmatory imaging were excluded. Demographics, injury characteristics, diagnosis timelines, management, and outcomes were recorded and analyzed using descriptive statistics.
Results:
Thirty-six patients (median age 14.9 years, IQR 13.8 to 16.6; 91.7% male) sustained posterior SC dislocations. Thirteen (36.1%) were missed at initial presentation, with delays up to 19 days (median 7, IQR 2 to 13). Missed cases occurred in both emergency (10/30, 33.3%) and outpatient (3/6, 50.0%) settings, with similar rates in those with (9/25, 36.0%) and without (4/11, 36.4%) clavicle fractures. Injuries most often resulted from a lateral shoulder blow (28/36, 77.8%), and 83.3% of patients with documented forward flexion had pain-limited motion. Most injuries (86.1%) were sports-related. Nearly all (97.2%) underwent surgical fixation without complications, and 77.4% with follow-up returned to sports.
Conclusions:
Over one-third of posterior SC joint dislocations were initially missed, with similar rates in patients with and without an associated clavicle fracture. These injuries are most often seen in the emergency department, typically from contact sports and a lateral blow to the shoulder. Given the risk of neurovascular injury, timely diagnosis is critical. Clinicians should maintain a high index of suspicion in patients with anterior chest pain after a lateral shoulder impact and when full forward flexion is pain-limited. Prompt recognition, CT imaging, and early orthopedic consultation are critical to ensure proper management and optimal outcomes.
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