Working Diagnosis:
Left interclavicular ligament tear

Treatment:
The patient underwent a series of ultrasound-guided dextrose prolotherapy injections to the interclavicular ligament. She had one injection of 1-2mL dextrose 50% to the left interclavicular ligament every two weeks for a total of ten injections over twenty weeks. An MRI chest without contrast was performed after completion of treatments, which showed a complete resolution of the previous ligament tear.

Outcome:
The patient's SC joint subluxation is mild and much improved from prior. She uses her left arm to do daily activities but continues to withhold herself from activities that increase stress to the area due to concurrent shoulder injuries.

Author's Comments:
The patient's symptomatic improvement with complete structural repair on MRI, depicts a novel case of dextrose prolotherapy to heal an interclavicular ligament tear.

Editor's Comments:
Sternoclavicular joint injuries are uncommon, representing less than 5 percent of all shoulder girdle injuries. Radiographs are the initial study of choice, with the serendipity (40 degree cephalad tilt) view most likely to assess displacement. CT imaging is the imaging method of choice in the suspicion of posterior dislocation and possible mediastinal injury. As demonstrated by this case, MRI has the advantage of superior visualization of isolated ligamentous injury.
Mild sprains and subluxations typically respond well to conservative care including sling use and activity restriction. In traumatic anterior dislocation, recurrent instability is common but long term functional impacts are not, and conservative management is typically used. Posterior dislocations with any concern for mediastinal injury is a surgical emergency and requires open reduction and internal fixation. Posterior dislocations less than 3 weeks old without evidence of mediastinal injury may be managed with closed reduction.
Novel treatments, such as the dextrose prolotherapy used in this case, lack sufficient literature evidence for standard of care, but may represent additional therapeutic options for severe or persistent symptoms. Treatments including platelet-rich plasma (PRP), tenotomy, shockwave therapy, and prolotherapy are designed to convert chronic, indolent, or incomplete healing response into acute injuries with possibility for greater healing response.

References:
Kiel J, Ponnarasu S, Kaiser K. Sternoclavicular Joint Injury. 2022 May 13. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2022 Jan. PMID: 29939671.
Morell DJ, Thyagarajan DS, Sternoclavicular joint dislocation and its management: A review of the literature. Worlk J Orthop. 2016 Apr 18;7(4):244-50. PMID: 27114931.
Stein A, McAleer S, Hinz M. Microperforation prolotherapy: a novel method for successful nonsurgical treatment of atraumatic spontaneous anterior sternocalvicular subluxation with an illustrative case. Open Access J Sports Med. 2011 Jun 7;2:47-52.

Return To The Case Studies List.