This was my third week at Crosshouse hospital and it was my first proper opportunity to get full time patient contact due to the previous two weeks being CT and in wards and theatres.

My skills felt quite rusty due to having no proper hands on experience for such a long period of time and I felt nervous. Protocols are also different at Crosshouse but I knew this from the last placement I had there. My first two days were mentally exhausting from double checking everything but I found it really exciting.

It was quite a slow week with not many clinics however during one orthopaedic clinic I encountered an interesting problem. The request was for a right sternoclavicular joint projection. The patient had sustained an injury which had caused subluxtion of the right sternoclavicular joint and was attending the department for a review examination from the orthopaedic consultant.

I had received a few requests from this particular orthopaedic consultant that I had not encountered before and had only read about in the positioning books which I found very interesting. These requests were for lateral scapula, sternoclavicular joints and acromioclavicular joints.

I talked the examination through with one of the radiographers; however she was also not confident in performing this exam. We then got the departments positioning book out for reference but then requested the help of a more experienced radiographer. It was acknowledged this was a rare request and due to the lack of familiarity of this particular position this examination was performed by the member of staff that felt most confident.

The positioning book dictated that we use the Kurzbauer method which states it is an unobstructed lateral projection of the sterno-clavicular articulation. This describes that the patient lies on the affected side with the arm they are lying on next to their head. Using a vertical central ray, directed 15 degrees caudally and centered to the lower most sterno-clavicular articulation. This technique was used but modified by the radiographer so the patient was positioned standing with the affected side against the upright bucky.

While observing this technique it seemed straight forward and relatively easy to perform. Once the image was obtained I found it difficult to interpret and had to get the radiographer to explain what we were looking at. After interpretation of the image it was difficult to see if any changes had occurred, as there were no previous images to compare them against. It is difficult to gain experience in these examinations since they are so rare. There was only one more request for a sternoclavicular joint that day and a different radiographer performed it while being observed.

Throughout the week I started to regain my confidence slowly with the examinations that are requested more frequently. However it took some time as I struggled to remember some protocols and also had to remember how to interact with the patients (radiology information system) RIS system.

I really enjoyed the experience of the various new referrals which had been requested while this clinic was on and I am really looking forward to tackling them in the future.

Attached to this piece of writing is an orthopaedic booklet on Sternoclavicular Joint Separation and images of the shoulder and the AC joint, and also a CT scan of a patient’s right and left sternoclavicular joints. Relative to the sternum, the left medial clavicle demonstrates 4 mm of superior subluxation. There is no detectable superior subluxation of the right medial clavicle.

Pearsall, A.W. and Russell, G.V. 2000. Ipsilateral Clavicle Fracture, Sternoclavicular Joint Subluxation, and Long Thoracic Nerve Injury: An Unusual Constellation of Injuries Sustained During Wrestling. The American Journal of sports medicine 28 (6) February, pp.904-8. Available at:http://ajs.sagepub.com/content/28/6/904.full.pdf+html [Acessed October 20 2010].

Eorthopod. 2010. Sternoclavicular problems. [online] Available at: http://www.eorthopod.com/content/sternoclavicular-joint-problems [Accessed October 20 2010].

Shoulder. 2010. Available at:http://www.projectswole.com/weight-training/the-top-5-best-shoulder-exercises/ [Accessed October 20 2010].

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A Patient Guide eOrthopod

 

This entry was posted on Tuesday, January 4th, 2011 at 7:15 pm and is filed under Reflectives. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.