Abstract
The sternoclavicular joint (SCJ) is the only bony connection between the upper limb and the axial skeleton. It is also the joint with the least bony congruency in the body, yet it is extremely stable thanks to a strong stabilising soft-tissue envelope of ligaments, muscles and tendons. Due to its central position and the strong stabilising envelope, injury and pathology around the SCJ is uncommon.
Instability of the joint is relatively rare and is best classified by Polar Type (Type I: Structural Traumatic, Type II: Structural Atraumatic, Type III: Muscle Patterning). Traumatic subluxation or dislocation of the SCJ usually requires significant force and the Sports Physician should be mindful of associated injuries. Damage or compromise to the posterior mediastinal structures is a risk with a posterior dislocation and should be considered as a potential medical emergency. Most anterior dislocations and posterior subluxations can be managed non-operatively, whilst an acute posterior dislocation, particularly in the presence of mediastinal compromise, may require an open reduction and stabilisation. Atraumatic structural and muscle patterning instability can usually be treated with non-operative measures including anti-inflammatory medication and physical therapy.
Rarely the SCJ disc can be damaged leading to symptoms of clicking and pain in overhead sports. This may be the result of a shearing injury in a normal disc but more commonly due to a tear in a degenerate disc. Osteoarthritis is relatively common in patients over 50 but usually asymptomatic. When troublesome it can lead to pain, crepitus and clicking at the joint, particularly in overhead sports. Most patients can be treated by non-operative measures.
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References
Lee JT, Campbell KJ, Mischalski MP, et al. Surgical anatomy of the sternoclavicular joint. J Bone Joint Surg Am. 2014;96(e166):1–10.
Warth RJ, Lee JT, Millett PJ. Anatomy and biomechanics of the sternoclavicular joint. Oper Tech Sports Med. 2014;22:248–52.
Emura K, Arakawa T, Terashima T, Miki A. Macroscopic and histological observations on the human sternoclavicular joint disc. Anat Sci Int. 2009;84(3):182–8.
Renfree KJ, Wright TW. Anatomy and biomechanics of the acromioclavicular and sternoclavicular joints. Clin Sports Med. 2003;22(2):219–37.
Spencer EE, Kuhn JE, Huston LJ, et al. Ligamentous restraints to anterior and posterior translation of the sternoclavicular joint. J Shoulder Elb Surg. 2002;11:43–7.
Tubbs RS, Loukas M, Slappey JB, et al. Surgical and clinical anatomy of the interclavicular ligament. Surg Radiol Anat. 2007;29:357–60.
Tubbs RS, Shah NA, Sullivan BP, et al. The costoclavicular ligament revisited: a functional and anatomical study. Romanian J Morphol Embryol. 2009;50(3):475–9.
Koch MJ, Wells L. Proximal clavicle physeal fracture with posterior displacement: diagnosis, treatment, and prevention. Orthopaedics. 2012;35(1):e108–11.
Webb PA, Schuey JM. Epiphyseal union of the anterior iliac crest and medial clavicle in a modern multiracal sample of American males and females. Am J Phys Anthropol. 1985;68:4567–466.
Ludewig PM, Behrens SA, Meyer SM, et al. Three-dimensional clavicular motion during arm elevation: reliability and descriptive data. J Orthop Sports Phys Ther. 2004;34:140–9.
Mehta JC, Sachdev A, Collins JJ. Retrosternal dislocation of the clavicle. Injury. 1973;5:79–83.
Wirth MA, Rockwood CA. Acute and chronic traumatic injuries of the sternoclavicular joint. J Am Acad Orthop Surg. 1996;4:268–78.
Thut D, Hergan D, Dukas A, et al. Sternoclavicular joint reconstruction: a systematic review. Bull NYU Hosp Jt Dis. 2011;69:128–35.
Tepolt F, Carry PM, Heyn PC. Posterior sternoclavicular joint injuries in the adolescent population: a meta-analysis. Am J Sports Med. 2014;42(10):2517–24.
Deutsch AL, Resnick D, Mink JH. Computed tomography of the glenohumeral and sternoclavicular joints. Orthop Clin North Am. 1985;16:497–511.
Yeh GL, Williams GR. Conservative management of sternoclavicular injuries. Orthop Clin North Am. 2000;31:189–203.
Sewell MD, Al-Hadithy N, Le Leu A, Lambert SM. Instability of the sternoclavicular joint. Current concepts in classification, treatment and outcomes. Bone Joint J. 2013;95B(6):721–31.
Rockwood CA, Wirth MA. Injuries to the sternoclavicular joint. In: Rockwood CA, Green DP, Bucholz RW, Heckman JD, editors. Rockwood and Green’s fractures in adults. 4th ed. Philadelphia: Lippincott-Raven; 1996. p. 1415–71.
Rockwood CA. Dislocations of the sternoclavicular joint. In: Evans EB, editor. American Academy of Orthopaedic Surgeons instructional course lectures, vol. XXIV. St Louis: CV Mosby; 1975. p. 144–59.
Nordqvist A, Petersson C. The incidence of fractures of the clavicle. Clin Orthop Relat Res. 1994;300:127–32.
Lyons FA, Rockwood CA Jr. Migration of pins used in operations on the shoulder. J Bone Joint Surg Am. 1990;72-A:1262–7.
Rockwood CA Jr, Odor JM. Spontaneous atraumatic anterior subluxation of the sternoclavicular joint. J Bone Joint Surg Am. 1989;71-A:1280–8.
Spencer EE, Kuhn JE. Biomechanical analysis of reconstructions for sternoclavicular joint instability. J Bone Joint Surg Am. 2004;86(1):98–105.
Martin SD, Altcheck D, Erlanger S. Atraumatic posterior dislocation of the sternoclavicular joint: a case report and literature review. Clin Orthop Relat Res. 1993;292:159–64.
Sonazaki H, Mitsui H, Miyanaga Y, et al. Clinical features of 53 cases with pustulotic arthro-osteitis. Ann Rheum Dis. 1981;40:547–53.
Tytherleigh-Strong G, Griffiths D. Arthroscopic excision of the sternoclavicluar joint for the treatment of strenoclavicular osteoarthritis. Arthroscopy. 2013;29:1487–91.
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Q&A
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(1)
Describe the stabilising structures of the sternoclavicular joint.
The stabilising structures are dynamic and static soft tissue structures. The static stabilisers are the inherent congruity of the articular surfaces of the medial end of the scapula and the sternal articulation, the anterior and posterior sternoclavicular ligaments, fibrocartilagenous disc, interclavicular and the costoclavicular ligament. The dynamic stabilisers make up the musculo-tendinous envelope around the joint.
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(2)
How would you classify sternoclavicular joint instability?
The Stanmore triangle is a useful system that takes into account the range of instabilities of the SCJ.
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(3)
What type of dislocation may lead to mediastinal compromise and what are the features?
Posterior mainly, with dysphagia, dyspnoea and/or vascular symptoms of venous congestion or oedema of the ipsilateral arm.
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(4)
Why is atraumatic instability of the SCJ more commonly in an anterior direction?
A much greater direct force is required to achieve a posterior dislocation compared to anterior.
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Tytherleigh-Strong, G., Pinder, E., Kennedy, M. (2020). The Sternoclavicular Joint. In: Funk, L., Walton, M., Watts, A., Hayton, M., Ng, C. (eds) Sports Injuries of the Shoulder. Springer, Cham. https://doi.org/10.1007/978-3-030-23029-6_9
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DOI: https://doi.org/10.1007/978-3-030-23029-6_9
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