A 30-year-old man sustains a hyperflexion injury to the shoulder in a road accident. He presents with severe dysphagia, hoarseness and stridor. CT chest shows compression of the mediastinum. The most likely injury is:

• A Anterior dislocation of the sternoclavicular joint
• B Fracture of the medial end of the clavicle
• C Rockwood Type III acromioclavicular dislocation
• D Posterior dislocation of the sternoclavicular joint ✓

Explanation

Posterior dislocation of the sternoclavicular joint drives the medial end of the clavicle into the superior mediastinum, compressing or injuring the trachea, oesophagus, great vessels or recurrent laryngeal nerve, producing dysphagia, hoarseness and stridor. It is a true emergency requiring closed or open reduction, ideally with a cardiothoracic surgeon available. Anterior dislocation is far more common but causes only a prominent bump with minimal functional problem. AC joint injuries never compromise the mediastinal structures.

Reference: Rockwood and Green's Fractures in Adults, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.