Surgical Technique for sternoclavicular joint

Mr Arpit Jariwala, Consultant Upper Limb and Trauma Surgeon at Ninewells Hospital and Medical School travelled to Leicester General Hospital, UK to meet fellow Consultant Orthopaedic Upper Limb Surgeon, Ms Alison Armstrong, who specialises in injuries and disorders of the sternoclavicular joint. The aim of Mr Jariwala’s visit was to gain a better understanding of the issues surrounding sternoclavicular joint disorders and to directly observe the surgical procedure therefore allowing it to be offered to carefully selected patients in NHS Tayside and educate our Master of Orthopaedic Surgery (MCh Orth) students here in Dundee accordingly.

Continued disability from injuries and disorders of the sternoclavicular joint are rare and are generally treated non-surgically. However, when conservative measures fail it is a difficult scenario due to the complexity of the surgical procedure owing to the critical surrounding structures making both patients and surgeons apprehensive of undertaking a surgical route. Upper Limb Units such as Leicester, Wrightington and Stanmore which regularly undertake these specialised surgeries around the sternoclavicular joint have noted good outcomes for surgical intervention following failed conservative management.

Mr Jariwala attended Ms Armstrong’s theatre on 4th April 2016 which consisted of examining a patient pre-operatively who had traumatic antero-superior instability, discussing treatment options, pre-operative planning, assisting in the sternoclavicular stabilisation surgery using the sternocleidomastoid muscle and discussing post-operative management plan. They also discussed several cases which Mr Jariwala had experienced in Dundee which in future may require surgical stabilisation of the sternoclavicular joint.

Left: Ms Alison Armstrong and Mr Arpit Jariwala prior to Theatre; Right: University Hospital of Leicester.

Mr Jariwala stated: “It was a brilliant training day with lots of pearls of wisdom regarding the management of these complex injuries and disorders and also plenty tips and tricks on surgical technique by Ms Armstrong; truly a well spent day!”