Touchdown Inc. 2 Posted November 13, 2012 Mike Tomlin said during his press conference that it is a "S.C. Shoulder sprain" Sternoclavicular (SC) joint injury What is a sternoclavicular joint injury? Sternoclavicular (SC) joint injury consists of ligament trauma to the joint connecting the breastbone [sternum] and the collarbone [clavicle]). It is an uncommon injury. When a ligament is subjected to acute strain, it may either stretch or tear, partially or completely. Such tearing of a ligament is known as a sprain and ranges from microscopic injury to complete disruption. This injury can occur either at its insertion on either bone, but most commonly occurs in its mid-substance. The sprain may result in partial joint displacement (“subluxation”) or complete separation of the joint surfaces (“dislocation”). Displacement can occur either anteriorly (collarbone translates towards the front) or posteriorly (collarbone displaces towards the back). What are the symptoms of sternoclavicular joint injury? At the time of injury, severe pain at the SC joint Occasionally symptoms may be severe due to posterior displacement of the medial clavicle, and can include hoarseness, difficulty swallowing, difficulty breathing, a sense of fullness about the neck or a choking sensation More chronic symptoms include pain around the SC joint, crepitus (crackling noise) and complaints of instability (clavicle feels like it “moves” anteriorly or posteriorly during activities) Some patients will experience pain over the SC joint when reaching across their body How is sternoclavicular joint injury diagnosed? History and physical exam are sufficient to establish a diagnosis in most cases. Acute SC joint pain accompanied by complaints of difficulty swallowing or breathing is a good indication of this condition. Other common signs include swelling, bruising and, occasionally, prominence of the medial (near midline) clavicle. X-rays are often difficult to interpret due to the multiple overlying structures and the complex 3-D anatomy of the normal chest. However, a “serendipity” view, in which the X-ray view is angled superiorly (at an angle upward towards the head), may yield some indication of the integrity of the sternoclavciular joint. Definitive evaluation requires 3-D imaging, such as a CT (Computerized Tomography) or MRI (Magnetic Resonance Imaging) scan. Are there any special tests? Occasionally patients with chronic symptoms may have a positive bone scan. This test involves administration of an IV contrast agent with detectable radio-isotope markers, followed by X-ray like scanning to see if there is increased uptake over the SC joint. Increased uptake suggests joint involvement, such as seen in acute injury or chronic arthritis. How is SC joint injury treated? Most SC joint injuries are subluxations (in which the joint is partially separated) rather than dislocations (in which the joint surfaces are completely displaced and remain unopposed). Treatment is influenced by this difference. Non-operative treatment is indicated for most patients, who are usually able to eventually resume pre-injury activities. Subluxations and anterior (towards the front) dislocations are usually treated non-operatively. Initial treatment consists of ice, pain medication and sling immobilization. Non-operative treatment is usually successful, with full return to activity and return of normal strength for most SC joint sprains. Return to activity is based on type of sport and the position played, the arm injured (dominant versus non-dominant), and the severity of the sprain. Residual deformity (prominence or relative loss of normal contour) of the medial end of the clavicle can be expected following SC joint injury, but in and of itself doesn’t require treatment. Operative treatment is uncommon and reserved for the few patients with respiratory distress due to posterior displacement of the medial clavicle, painful prominence of the medial clavicle, or those who develop painful post-traumatic arthritis of the SC joint. What are the complications of treatment? Possible complications of non-operative treatment: Persistent pain or post-traumatic arthritis following SC joint injury are uncommon. In acute posterior dislocation, the biggest risk is to the surrounding vital structures near the injury, e.g, the trachea (windpipe), esophagus (tube from mouth to stomach), and important vessels immediately behind the medial border of the clavicle. Failure to recognize compression of vital structures due to posterior displacement of the medial end of the clavicle can be life-threatening. Possible complications of operative treatment: Surgical intervention is uncommon. If a patient continues to have pain and/or dysfunction after appropriate non-operative treatment, surgery to resect (surgically remove) the medial end of the clavicle may be warranted. Surgical resection of the medial clavicle in cases of chronic post-traumatic pain following SC Joint injury has few surgical complications, although care must be taken to avoid overly-generous resection (and inadvertent de-stabilization of the SC joint). Operative complications not specifically related to the SC joint include pain, bleeding (uncommon), infection (<1percent), nerve injury (rare), stiffness, problems with anesthesia, and inability to return to previous level of pre-injury activity. When can you return to your sport/activity? Over time, symptoms typically will resolve. The exact healing time varies with the severity of the injury (mild sprain, subluxation or dislocation), which arm was injured (dominant versus nondominant), and type of sport and position played. Surgical treatment requires a period of convalescence to permit tissue healing. Share this post Link to post Share on other sites
Gandalfthecat 8 Posted November 13, 2012 Could be more specific? Share this post Link to post Share on other sites
Gouda-Buddha 0 Posted November 13, 2012 A timeline for recovery would be great! Thought that might be important... Share this post Link to post Share on other sites
NewbieJr 540 Posted November 13, 2012 The word 'sprain' is like using the words boo boo. It pretty much covers any soft tissue injury. That could be anything from missing 6 weeks to being a game time decision this week. Share this post Link to post Share on other sites
ian Potter 9 Posted November 13, 2012 I had same exact injury plus an AC separation after wrecking my motorcycle a few years ago. I was immobile for 8 weeks and had surgery and would help eliminate my shoulder abnormality (large bump from accident) I was told that it would heal faster with surgery. All I know is it was painful and had little mobility. I'm guessing he's out atleast a month. If you own him as a starter I'd start scrambling for a replacement or backup, Steelers playoff window is closing quickly! EDIT: His is a bit different. Only classifying it as a sprain. Mine were two tears. Might be back sooner. Think 4 games at most. Share this post Link to post Share on other sites
mr_bungalow 1 Posted November 13, 2012 They were talking about this on Fantasy Sports Radio this morning and said that we'll know more when they announce a level. 3 is the worst (6+ wks until he's back), 1 is the best (could be back after a week off). Share this post Link to post Share on other sites
jocstrap 8 Posted November 13, 2012 welp, there's one bold prediction that might be correct Share this post Link to post Share on other sites
edjr 5,567 Posted November 13, 2012 you don't leave your home stadium to go to the hospital for a sprained shoulder, you do that for a broken collar bone Share this post Link to post Share on other sites
NewbieJr 540 Posted November 13, 2012 you don't leave your home stadium to go to the hospital for a sprained shoulder, you do that for a broken collar bone I'd be shocked to learn his collarbone was broken. He jogged off the field and his arm was extended. Broken collarbones are so painful that mostguys I've seen with them have the shoulder slouched down and their arm held up against their chest like they're pledging allegience to the flag. Share this post Link to post Share on other sites
ian Potter 9 Posted November 13, 2012 They were talking about this on Fantasy Sports Radio this morning and said that we'll know more when they announce a level. 3 is the worst (6+ wks until he's back), 1 is the best (could be back after a week off). this is also true Share this post Link to post Share on other sites
