Description:
Sternoclavicular (SC) injuries are relatively uncommon but can cause significant pain and hinderance to performance. In this blog post, we’ll delve into the mechanisms, signs, symptoms, anatomy, assessment, and management strategies for sternoclavicular injuries.
Mechanism of Injury:
Sternoclavicular joint injuries typically occur due to falls on the outer aspect of the shoulder which transmits force from the outer shoulder to the clavicle (collarbone) near the sternum (breastbone). This force causes the collarbone to move forward or backward. This may result in a subluxation or dislocation.
Anatomy:
The SC joint is the only bony joint that connects the axial (Central/Midline) skeleton to the appendicular (Peripheral) skeleton. The joint is formed by the Clavicle (collarbone) and Sternum (breastbone). Between these 2 bones there is a disc. Furthermore, the joints are held in place by ligaments which provide anterior/forward and posterior/backward stability.
- Signs and Symptoms:
- Pain and swelling at the clavicle and sternum junction.
- Reports of clicking/popping.
- Complaints of instability.
- Step deformity.
- Feelings of shortness of breath, choking or tight feeling in the throat in situations where the dislocation is in the direction of the chest.
Assessment:
Emphasis is place on making an accurate diagnosis. The above signs and symptoms are observed and assessed. Additionally, imaging in the form of an x-ray and/ or ultrasound may be required to confirm any subluxation or dislocation and associated ligament injury.
Management:
- Initial management will place focus on protecting the site of injury.
- Immobilization of the upper limb in a sling.
- Referral to an orthopaedic surgeon may be necessary.
- To manage pain, swelling and inflammation, rest, the use of ice, and topical anti-inflammatory is encouraged.
- Whilst the above settles, it is important to maintain function and strength through exercise in the wrist and elbow without placing load/pressure on the shoulder.
- Once enough time has been given to allow the SC joint to heal, it is important that shoulder mobility be regained to prevent complications.
- Gradual strengthening of shoulder.
References
Groh, G.I. and Wirth, M.A. (2011) ‘Management of traumatic sternoclavicular joint injuries’, American Academy of Orthopaedic Surgeon, 19(1), pp. 1–7. doi:10.5435/00124635-201101000-00001.
Ingoe, H.M.A. et al. (2023) ‘Traumatic posterior sternoclavicular joint dislocation – current aspects of management’, Injury, 54(11), p. 110983. doi:10.1016/j.injury.2023.110983.
Justin E. Hellwinkel, Eric C. McCarty & Morteza Khodaee (2019) Sports-related sternoclavicular joint injuries, The Physician and Sportsmedicine, 47:3, 253-261, DOI: 10.1080/00913847.2019.1568771
Morell, Daniel & Thyagarajan, David. (2016). Sternoclavicular joint dislocation and its management: A review of the literature. World Journal of Orthopaedics. Vol 7. 244-250. 10.5312/wjo.v7.i4.244.
Rosie Helen Broadbent, Sarah Mary Barkley, Margo Dirckx, Hassaan Sheikh, The sternoclavicular joint: a review of anatomy, injury and management, Orthopaedics and Trauma, Volume 37, Issue 5, 2023, Pages 314-319.
