1. Shoulder Injuries
  2. Sternoclavicular Injury
Sternoclavicular Separation
 
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The sternoclavicular (SC) joint is a freely moveable joint that connects the arm and shoulder to the torso at the sternum (breastbone). The SC joint allows unrestricted motion of the clavicle in all planes.

The joint is supported by four strong ligaments:
  • Interclavicular ligament.
  • Anterior sternoclavicular ligament.
  • Posterior sternoclavicular ligament.
  • Costoclavicular ligament.
Injuries to the SC joint are infrequent and are typically the result of direct force to the clavicle which results in separation of the joint.
SC separations are graded on the degree of injury to the tissues.
  • Grade I: a mild sprain, the ligaments (sternoclavicular and costoclavicular) are stretched, but not torn.
  • Grade II: a moderate sprain, some of the ligaments are torn. There is some anterior or posterior dislocation. These sprains may involve some loss of function.
  • Grade III: a severe sprain, there is a complete tear all the way through the ligament. These are significant injuries that require medical or surgical care to ensure recovery. As the ligament there is a complete dislocation of the clavicle.
Symptoms include:
  • Anterior dislocation: severe shoulder pain which increases with arm movement and a noticeable bump in the middle of the chest.
  • Posterior dislocation: difficulty breathing and swallowing.
  • Clicking or grating from interclavicular ligament injury.
Treatment:
Non-surgical treatment
  • Protection from further injury with an abduction pillow, abduction brace or sling.
  • Rest, limiting movement of the injured elbow as much as possible.
  • Cold therapy to stimulate blood flow and relieve the shoulder pain associated with inflammation. Cold therapy should be applied several times over the course of the day.
  • Nonsteroidal anti-inflammatory medications (NSAIDs) such as Ibuprofen, Motrin, Naprosyn and Celebrex may be used to decrease shoulder pain. Be sure to talk to your doctor before starting these medications.
  • Reduction (re-alignment) of the SC joint.
Surgical treatment
Surgery is typically employed for posterior dislocations and severe anterior dislocations.
  • The surgery of choice is a resection arthroplasty (removal of one or both articular surfaces of a joint). This prevents the bone surfaces from rubbing against one another. Scar tissue will then secure the clavicle.
  • Tendon graft. A tendon is taken from the wrist and sewn to connect the clavicle and the first rib.


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Sternoclavicular Injury