I wrote some time ago about ‘Matt’, who at the time was a 16 year old rugby league player. You will recall he had suffered a posterior sterno-clavicular fracture-dislocation at the physeal plate. I have an update on his further progress.
Matt was initially seen by a shoulder specialist with no previous experience in sternoclavicular injuries, who had suggested a conservative approach to management. However soon after, that specialist sought further advice from Dr David Duckworth. Dr Duckworth had seen 3 previous cases of SC dislocation. After examining Matt with his CT scan, it was decided to perform an open reduction and stabilization of the SC joint. This was carried out 5 weeks after the initial injury.
At operation the clavicle was locked in a posteriorly dislocated position, and had to be released and placed back in an anatomical position. The clavicle was then sutured to the physis and sternum with Ethibond sutures. Matt was placed in a sling for 4 weeks and returned to see me at 6 weeks.
Treatment commenced with thoracic and A/C joint mobilisation, scapular retraction exercises, passive and active assisted low level range of motion, and isometric strength in neutral. Range of motion and strength was gradually progressed in range. He had full range of motion within one further month, and close to normal strength on dynamometry testing at 4 months, with normal strength at 6 months. He returned to sport after 3 months post-op. He still had a mild degree of scapular protraction and winging.
It is now 18 months since his surgery, and Matt has continued to play full contact Rugby League, and has no further problems with the shoulder.
For a detailed overview of sternoclavicular injuries see my literature review: http://www.cssphysio.com.au/pdfs/1-Literature-Review-.pdf
For information for doctors on physiotherapy management of all types of injuries visit:
Information for patients is at:
Concord Sport & Spine Physiotherapy
202 Concord Road
Concord West, NSW 2138
Sydney, Australia.
Ph (02) 9736 1092
Email: info@cssphysio.com.au
Web: www.cssphysio.com.au
Copyright © 2016 Paul Monaro. All Rights Reserved
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