J Korean Fract Soc.  2013 Jan;26(1):60-64. 10.12671/jkfs.2013.26.1.60.

Costoclavicular Syndrome Secondary to Nonunion of a Displaced Fracture of the Clavicle, Misdiagnosed as a Simple Muscle Strain: A Case Report

• Jeon HS
• Noh HK
• Kang SG
• Kim JM
• Jeon SJ

• KMID: 1431719
• DOI: http://doi.org/10.12671/jkfs.2013.26.1.60

Abstract

Thoracic outlet syndrome is a relatively common disease. However, costoclavicular syndrome as a condition secondary to nonunion of a displaced fracture of the clavicle is very rare. Most clavicular fractures in adults are united with no or minimal persistent symptoms. Also, symptomatic nonunion of a displaced fracture of the clavicle is rare. A 55-year-old male initially presented with persistent forearm pain after slip-down was initially diagnosed with simple muscle strain. However, he was given a delayed diagnosis of costoclavicular syndrome, caused by compression of the subclavian artery due to trauma in the fibrotic nonunion of the right clavicle without apparent symptoms. We obtained satisfactory results by surgical treatment. Here we report this case with a review of the literature.

Keyword

Clavicle; Simple muscle strain; Nonunion; Costoclavicular syndrome

MeSH Terms

Adult
Clavicle
Delayed Diagnosis
Forearm
Humans
Male
Muscles
Sprains and Strains
Subclavian Artery
Thoracic Outlet Syndrome

Figure

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  Fig. 1 Preoperative radiograph shows a fibrous nonunion and displacement with shortening of the clavicle shaft.

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  Fig. 2 Preoperative 3dimension computed tomography shows displacement and shortening of the clavicle shaft.

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  Fig. 3 Preoperative angio computed tomography shows the discontinuous subclavian artery under the fracture site.

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  Fig. 4 Preoperative angiogram shows the discontinuous subclavian artery beneath the fracture site with little collateral circulation.

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  Fig. 5 Postoperative angiogram shows restoration of circulation at the brachial artery, distal to the fracture site.

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  Fig. 6 Postoperative radiograph shows the union of the fracture site with no displacement.

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