The sternoclavicular (SC) joint is a major joint of the upper body that is formed by the articulation of the collarbone (clavicle) and the center of the chest (manubrium). Most of the SC joint’s strength and stability originates from the joint capsule and supporting ligaments. SC joint injuries are often due to a direct blow or blunt force trauma that occurs to the collarbone. These injuries can also result from a traumatic landing to the shoulder area (such as in football). SC joint injuries are typically associated with a disruption of the supporting ligaments.
A sternoclavicular (SC) joint injury is relatively uncommon, but when it occurs, the affected ligaments are stretched or torn (partially or completely) causing the joint to become disrupted. Sternoclavicular joint injuries are graded into 3 types ranging from a first-degree injury that involves a simple sprain or stretching of the ligaments, to a second-degree injury where a portion of the clavicle becomes subluxated. In the most severe cases (a third degree SC joint injury), a complete rupture typically occurs between the sternoclavicular and costoclavicular ligaments, which permits the clavicle to completely dislocate from the manubrium.
The most common symptoms from an SC joint injury include:
- Severe pain at or around the SC joint at the time of injury and afterwards
- Bruising in the area
- Difficulty swallowing, difficulty breathing, a sense of fullness around the neck or a feeling of choking sensation due to posterior displacement of the medial clavicle
- Cracking noises, popping sounds
- A feeling of instability where the clavicle feels like it “moves” during activities
Dr. Anz will conduct a thorough examination of the shoulder blade and collarbone. He will test for tenderness and pain, and evaluate the overall range of motion of the arm and shoulder. In some cases, he will be able to see if a dislocation or other major disruption has occurred, but an X-ray will usually confirm his diagnosis. Because ligaments and other soft tissue structures are typically involved with these injuries, he may also order an MRI to take a more in-depth look at this area.
Surgery is not necessary for most SC joint injuries. Initial treatment consists of ice, pain medication and sling immobilization. Return to activity is based on type of sport and the position played, the arm injured (dominant versus non-dominant), and the severity of the sprain. In more acute cases, a reduction (or relocation) of the SC joint can be attempted by sedating the patient and pulling gently on the arm, manipulating it back into its normal position. This may allow the SC joint to ‘pop’ back into position.
Operative treatment is reserved for patients who experience major trauma to the bones and ligaments of the SC joint. Dr. Anz will choose the type of surgery based on the exact injury, but in many cases will opt for a stabilization procedure that will allow him to reattach or repair any loose or torn ligaments of the SC joint. Without this stabilization procedure, a patient is a risk for future dislocations and/or subluxations, as well as the onset of arthritis.
Following surgery for an SC joint injury, it is critical that patients follow the prescribed post-op rehabilitation program as set forth by Dr. Anz. These guidelines will be broken down into phases and will be conducted with a therapist, and at home. Most patients are able to resume normal activities within 3-6 months; sports and other high impact activities may take longer.
For more information on sternoclavicular joint injuries or for additional resources on the other shoulder related injuries and conditions, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute.