Special X-ray Views for Sternoclavicular Dislocation
CT scan is the best method for diagnosing sternoclavicular joint dislocation, while specialized plain radiographic views such as the serendipity view are recommended when CT is not immediately available. 1, 2
Standard Radiographic Approach
- Initial evaluation should include standard radiographs with at least three views: anteroposterior (AP) views in internal and external rotation, and an axillary or scapula-Y view 3
- Standard AP radiographs alone are often inadequate for visualizing sternoclavicular joint dislocations due to overlapping structures 3, 4
- The sternoclavicular joint is difficult to visualize on routine radiographs because of the overlapping mediastinal structures 1, 5
Specialized Plain Film Views
When CT is not immediately available, specialized radiographic views can help visualize the sternoclavicular joint:
- Serendipity view: A 40° cephalic tilt view that projects the sternoclavicular joints away from the thoracic spine, allowing better visualization of anterior or posterior displacement 4, 5
- Rockwood view: An upright 30° angled caudad radiograph that can help visualize the sternoclavicular region 3
- Hobbs view: A supine oblique projection with the x-ray tube angled 15° toward the affected side 1
- Heinig view: A view with the patient supine and the x-ray tube angled 15° cephalad 1
Advanced Imaging Recommendations
- CT scan is the gold standard and recommended imaging modality for both diagnosis of sternoclavicular dislocation and evaluation of potential complications 2, 5
- CT provides superior visualization of the sternoclavicular joint and can accurately determine the direction of dislocation (anterior vs. posterior) 1, 2
- CT is particularly important for posterior dislocations to assess for potential injury to mediastinal structures including the trachea, esophagus, and major vessels 2, 5
- 3D reconstructions from CT data can further enhance visualization of the displacement 5
Clinical Considerations
- Posterior sternoclavicular dislocations require more urgent diagnosis and treatment due to potential life-threatening complications from compression of mediastinal structures 2, 5
- In adolescent patients, physeal injuries should be suspected rather than true dislocations, as the medial clavicular physis is the last to close (around age 25) 4
- When vascular compromise is suspected with posterior dislocations, CT angiography should be considered 4
Common Pitfalls
- Relying solely on standard AP radiographs often leads to missed diagnoses of sternoclavicular dislocations 1, 4
- Failure to obtain specialized views or CT imaging when sternoclavicular injury is suspected can result in delayed diagnosis and treatment 2, 5
- In posterior dislocations, delay in diagnosis can lead to serious complications including vascular or airway compromise 2
- Misinterpreting a physeal injury as a dislocation in younger patients can lead to inappropriate management 4