Congenital Pseudoarthrosis of the Clavicle Q74.0

synonyms: clavicle pseudoarthrosis

Clavicle Pseudoarthrosis ICD-10

• Q74.0 Other congenital malformations of upper limb(s), including shoulder girdle

Clavicle Pseudoarthrosis Etiology / Epidemiology / Natural History

• rare
• etiology unknown, theories=intrinsic failure vs compression
• subclavian artery may compress developing right clavicle which might explain right sided predominance and occurrence on left with dextrocardia
• 90% right sided.
• no association with neurofibromatosis
• most are right sided, 10% bilitaeral,(associated with cervical ribs) rarely left sided.
• right > left
• rare to be bilateral

Clavicle Pseudoarthrosis Anatomy

• First bone to ossify, 5^thgestational week
• Only long bone to ossify be intramembranous ossification
• Medial physis=80% of longitudinal growth
• Both acromial and sternal physes can remain open into 3^rddecade of life.

Clavicle Pseudoarthrosis Clinical Evaluation

• prominent, palpable mobile, middle third of the clavicle at birth of soon after
• shoulder appears dropped, arm slightly closer to midline
• painfree
• normal shoulder ROM
• no hx of trauma or tenderness

Clavicle Pseudoarthrosis Xray / Diagnositc Tests

• osseous separation of clavicle with enlarged, rounded ends without fracture callus

Clavicle Pseudoarthrosis Classification / Treatment

• generally non-operative. Spontaneous bony union does not occur, but patients generally have minimal pain and normal function.
• Rare but potential complications: pain at pseudoarthrosis site, shoulder asymmetry, decreased motion, thoracic outlet syndrome.
• Surgery indicated only for severe prominence after appropriate PT counseling
• Surgerical options:
  -Infant: resection of fibrous tissue/sclerotic bone with periosteal repair
  -Children (prepubertal): excision of pseudoarthrosis, grafting and plating.
  -Adults (postpubertal): excision of prominence without ORIF.

Clavicle Pseudoarthrosis Associated Injuries / Differential Diagnosis

• traumatic clavicle fx
• cleidocranial dysostosis(AD, paritial or total absence of the clavicle, frontal bossing, diastasis of pubic symphysis)
• neurofibromatosis
• skeletal dyspasias

Clavicle Pseudoarthrosis Complications

• infection
• nonunion
• brachial plexus injury
• Rare but potential complications of non-op treatment: pain at pseudoarthrosis site, shoulder asymmetry, decreased motion, thoracic outlet syndrome.

Clavicle Pseudoarthrosis Follow-up Care

• Activities as tolerated

Clavicle Pseudoarthrosis Review References

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