Expert: Dr. Victor Dolan, DC, DACBSP - 9/6/2011

Question
I am on Ortho Dr #3, who after the internet pages & CT comparison (R/L) agrees with me I have had a SCJ dislocation two years ago. He wants me to have a CT guided steroid injection.  I would like to have the reduction.  His PA thinks they are not successful, and he is not willing to pass me the names of the three Surgeons he would recommend (they will advise me on what I should have done...).  I am planning to live a very long time, so I need the long term fix.  Is this just a waste of time and money on yet another insurance checklist?

Answer
SCJ dislocation, Sternal-Clavicular Joint Dislocation, AC Joint, Acromio-Clavicular joint, Staten Island Chiropractor, Kinesio Tape, Manipulation, Staten Island Sports Doctor,





Hello Alberta,

I am sorry to hear of your continued pain and dysfunction.   Thank You for your question, I hope I can be helpful.   If I leave something out, or if you need further information, do not hesitate to RE-contact your Staten Island Chiropractor expert at:  http://www.allexperts.com/ep/965-100794/Chiropractors/Victor-Dolan-DC-DACBSP.htm

Alberta, you are on Orthopedic Doctor number three (and I am making assumptions: Orthopedic Surgeon Medical Doctor, and SCJ = Sternal-Clavicular Joint).  These doctors have examined you IN PERSON - what is their opinion?  Do these docs agree? disagree?  Are you in a lot of pain, some pain, little pain, no pain?  Do you have a lot of dysfunction, inability to use your arm fully, mild dysfunction?  What happened two years ago, do you remember a traumatic event, a sports injury, a car accident?  What have you done in the past, what are you doing now for this complaint?  Have you seen a Physiatrist MD- perhaps injection or exercise therapy could be helpful?  Have you seen a Physical Therapist- perhaps therapy, manipulation, massage could be helpful?  Have you seen a Doctor of Chiropractic, and there are various specialties possibly applicable to your case- see:  http://www.acatoday.org/pdf/ApprovedChiropracticSpecialtyPrograms.pdf   
Perhaps a Chiropractic Orthopedist would be good for your complaint, perhaps a DC Rehab Specialist, perhaps even a Chiropractic Doctor with a sports injury credential (ie DACBSP)?

I am NOT against you having a surgical correction, a surgical reduction,,,,, BUT--- once you have an invasive procedure- i.e.: surgery, and you change the architecture that Mother Nature gave us,,,,,, perhaps the outcome can be good, perhaps the outcome can be worse than you already have!  Only YOU can decide if the Risk/Benefit ratio of an invasive procedure is 'worth it'.

Are you in terrible pain, with terrible dysfunction???, Then perhaps I would go for surgery,,, after all, even if the surgery fails, it cannot get worse.

Are you functioning, and have little or episodic pain???, then perhaps trying more conservative and different approaches may be worthwhile before proceeding to surgery.  Only YOU can weigh the Risk/ Benefit Ratio, the odds, the chances.

Your Sterno-Clavicular Joint is actually the only joint, the closest connection, your ENTIRE shoulder apparatus has to your torso, your body.   Alteration here may improve shoulder dynamics, or may not; again - only YOU can decide if it is 'worth it'.  But once the architecture is changed, then there is less that conservative approaches Acupuncture, Chiropractic, Massage, Nutrition, Physical Therapy, Kinesiology taping, can do for you.

Some interesting internet sources may help you:
http://en.wikipedia.org/wiki/Sternoclavicular_articulation
http://emedicine.medscape.com/article/828642-overview


  of particular interest: http://emedicine.medscape.com/article/828642-treatment#a1126
Sprains of the SCJ require only symptomatic treatment (ie, immobilization with a sling, ice for 24-48 h, analgesics, and anti-inflammatory medications).

Acute anterior dislocations usually can be treated nonoperatively, but interposition of the joint capsule or the ligaments can make the joint irreducible. Additionally, maintaining reduction of anterior dislocations often is difficult.[8] If indicated, carry out closed reduction of an anterior dislocation as follows:

•Place the patient in a supine position on the stretcher.
•Place a 3- to 4-inch thick bolster (rolled sheet or sandbag) between the scapula and spine (to help separate the clavicle from the manubrium).
•Have an assistant abduct (to 90°) and extend (10-15°) the shoulder on the affected side and apply traction.
•If reduction does not occur, apply pressure to the medial clavicle in a posterior and inferior direction.
************•Treatment options for recurrent/unreduced anterior SCJ dislocations may include open reduction and internal fixation, or acceptance of some degree of permanent instability, depending on the patient's characteristics and functionality.
•Closed reduction with conscious sedation or general anesthesia, while the preferred initial treatment, may not be possible. Because of potential associated vascular injury, the operating room may be the more appropriate setting for reduction.*******************************
Acute posterior dislocations are a more serious injury because of their association with vascular injuries to the intrathoracic and superior mediastinal structures and are typically reduced in an operating room with the patient under general anesthesia.   http://emedicine.medscape.com/article/828642-treatment#a1126


http://www.chiro.org/cases/ABSTRACTS/Sternoclavicular_Joint_Dislocation.shtml  
 
".......After closed reduction for anterior dislocation, your SC joint will need to be held perfectly still. Moving the SC joint will cause pain and may even dislocate the joint again. Your doctor will probably recommend that you take pain medication and wear a figure-eight strap for at least six weeks........" http://www.eorthopod.com/content/sternoclavicular-joint-problems

http://orthopedics.about.com/od/shoulderelbow/a/scjoint.htm

RESULTS of SURGERY:  http://www.ncbi.nlm.nih.gov/pubmed/16439906

http://www.concordortho.com/patient-education/topic-detail-popup.aspx?topicID=1c

I hope these resources give you further background information.

Now, directly to your question:
".....I am on Ortho Dr #3, who after the internet pages & CT comparison (R/L) agrees with me I have had a SCJ dislocation two years ago......"- What does the majority opinion say?  These doctors have actually SEEN you physically= far more important than us internet experts......

"...... He wants me to have a CT guided steroid injection......", a steroid injection COULD calm the pain, break the pain cycle, defuse the inflammation, this is worth considering.  Perhaps an injection, followed by a closed reduction (manipulation) followed by supportive taping (ie kinesio taping see: http://www.kinesiotaping.com/ ), bracing, or sling.

"....I would like to have the reduction......"- weigh all of the information given above,,,, NOT knowing how badly you are hurting/ functioning.... I am not sure surgery will be helpful.....

".......His PA thinks they are not successful, and he is not willing to pass me the names of the three Surgeons he would recommend (they will advise me on what I should have done...)......."- the PA, or an MD, or a DC, ---- cannot withold treatment option information.  GET THE NAMES OF ALTERNATIVE TREATMENTS-  ALTERNATIVE DOCTORS,  no one doctor has all the answers, and--- when patients ask for options, we HAVE to give the patient that option information.

".......I am planning to live a very long time, so I need the long term fix......", please do NOT think of surgery as a guaranteed long term fix.  Once we change the architecture of the body,,,, compensations often develop elsewhere in that body, changes occur, increased arthritis can occur.  Weigh the risks/ benefits; including compensatory changes, arthritic degeneration, and etc- see above.

".... Is this just a waste of time and money on yet another insurance checklist?........", I am not really sure what this portion of your question means......

I hope this information and my opinion is helpful.  Do not hesitate to recontact me if you need further. Good luck!

Your Staten Island Chiropractic Expert,
Dr. Victor Dolan, DC, DACBSP