Michigan State University College of Human Medicine, Kalamazoo, MI, USA (Stewart)Bronson Methodist Hospital, Kalamazoo, MI, USA (Stewart)Department of Emergency Medicine, Michigan State University/Kalamazoo Center for Medical Studies, Kalamazoo, MI 49008-1284, USA (Van Klompenberg)
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A 27-year-old woman presented to the emergency department after a rollover motor vehicle collision. She complained of right shoulder and upper chest pain worse with movement of the arm. She had marked tenderness over the right clavicle with mild local swelling. There was no bony crepitus, and the result of her neurovascular examination was normal. Radiographs of the right shoulder were normal. The chest radiograph (Fig. 1A) showed the medial head of the right clavicle extending beyond the midline (arrow). Follow-up computed tomographic angiogram revealed a posterior dislocation of the right clavicle (Fig. 1B and C) at the sternoclavicular joint with 50% compression of the left subclavian vein. The patient was taken immediately to the operating room for reduction. The reduction was achieved by applying traction with the arm abducted 90° and slightly extended while the clavicle was pulled anteriorly with percutaneous towel clips. She was discharged home with a figure-of-8 splint to be worn for 6 weeks.