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The Sternoclavicular Joint

  • Graham Tytherleigh-Strong
Chapter

Abstract

The SCJ is the only bony connection between upper limb and the axial skeleton. It is 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. 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 an ever-present 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 is sometimes 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.

Keywords

Sternoclavicular joint Dislocation Instability Medial physeal fracture Disc Osteoarthritis 

References

  1. 1.
    Warth RJ, Lee JT, Millett PJ. Anatomy and biomechanics of the sternoclavicular joint. Oper Tech Sports Med. 2014;22:248–52.CrossRefGoogle Scholar
  2. 2.
    Lee JT, Campbell KJ, Mischalski MP, et al. Surgical anatomy of the sternoclavicular joint. J Bone Joint Surg Am. 2014;96(e166):1–10.Google Scholar
  3. 3.
    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.CrossRefGoogle Scholar
  4. 4.
    Renfree KJ, Wright TW. Anatomy and biomechanics of the acromioclavicular and sternoclavicular joints. Clin Sports Med. 2003;22(2):219–37.CrossRefGoogle Scholar
  5. 5.
    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.CrossRefGoogle Scholar
  6. 6.
    Tubbs RS, Loukas M, Slappey JB, et al. Surgical and clinical anatomy of the interclavicular ligament. Surg Radiol Anat. 2007;29:357–60.CrossRefGoogle Scholar
  7. 7.
    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.Google Scholar
  8. 8.
    Koch MJ, Wells L. Proximal clavicle physeal fracture with posterior displacement: diagnosis, treatment, and prevention. Orthopaedics. 2012;35(1):e108–11.Google Scholar
  9. 9.
    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.Google Scholar
  10. 10.
    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.CrossRefGoogle Scholar
  11. 11.
    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;95-B(6):721–31.CrossRefGoogle Scholar
  12. 12.
    Mehta JC, Sachdev A, Collins JJ. Retrosternal dislocation of the clavicle. Injury. 1973;5:79–83.CrossRefGoogle Scholar
  13. 13.
    Wirth MA, Rockwood CA Jr. Acute and chronic traumatic injuries of the sternoclavicular joint. J Am Acad Orthop Surg. 1996;4:268–78.CrossRefGoogle Scholar
  14. 14.
    Thut D, Hergan D, Dukas A, et al. Sternoclavicular joint reconstruction: a systematic review. Bull NYU Hosp Jt Dis. 2011;69:128–35.PubMedGoogle Scholar
  15. 15.
    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.CrossRefGoogle Scholar
  16. 16.
    Deutsch AL, Resnick D, Mink JH. Computed tomography of the glenohumeral and sternoclavicular joints. Orthop Clin North Am. 1985;16:497–511.PubMedGoogle Scholar
  17. 17.
    Yeh GL, Williams GR Jr. Conservative management of sternoclavicular injuries. Orthop Clin North Am. 2000;31:189–203.CrossRefGoogle Scholar
  18. 18.
    Tytherleigh-Strong G, Pecheva M, Titchener A. Treatment of first-time traumatic anterior dislocation of the sternoclavicular joint with surgical repair of the anterior capsule augmented with internal bracing. Orthop J Sports Med. 2018;6(7):1–7.CrossRefGoogle Scholar
  19. 19.
    Bak K, Fogh K. Reconstruction of the chronic anterior unstable sternoclavicular joint using a tendon autograft: medium-term to long-term follow-up result. J Shoulder Elb Surg. 2014;23:245–50.CrossRefGoogle Scholar
  20. 20.
    Rockwood CA. Dislocations of the sternoclavicular joint. In: Evans EB, editor. American Academy of Orthopaedic Surgeons Instructional Course Lectures: Volume XXIV. CV Mosby: St Louis; 1975. p. 144–59.Google Scholar
  21. 21.
    Lafosse JM, Espie A, Bonnevialle N, Mansat P, Tricoire JL. Posterior dislocation of the sternoclavicular joint and epiphyseal disruption of the medial clavisle with posterior displacement in sports participants. J Bone Joint Surg Br. 2010;92:103–9.CrossRefGoogle Scholar
  22. 22.
    Spencer EE, Kuhn JE. Biomechanical analysis of reconstructions for sternoclavicular joint instability. J Bone Joint Surg Am. 2014;86(1):98–105.CrossRefGoogle Scholar
  23. 23.
    Morell DJ, Thyagarajan DS. Sternoclavicular joint dislocation and its management. A review of the literature. World J Orthop. 2016;7:244–50.CrossRefGoogle Scholar
  24. 24.
    Nordqvist A, Petersson C. The incidence of fractures of the clavicle. Clin Orthop Relat Res. 1994;300:127–32.Google Scholar
  25. 25.
    Lyons FA, Rockwood CA Jr. Migration of pins used in operations on the shoulder. J Bone Joint Surg Am. 1990;72-A:1262–7.CrossRefGoogle Scholar
  26. 26.
    Rockwood CA Jr, Odor JM. Spontaneous atraumatic anterior subluxation of the sternoclavicular joint. J Bone Joint Surg Am. 1989;71-A:1280–8.CrossRefGoogle Scholar
  27. 27.
    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.CrossRefGoogle Scholar
  28. 28.
    Sonazaki H, Mitsui H, Miyanaga Y, et al. Clinical features of 53 cases with pustulotic arthro-osteitis. Annals Rheum Dis. 1981;40:547–53.CrossRefGoogle Scholar
  29. 29.
    Lawrence CR, East B, Rashid A, Tytherleigh-Strong GM. The prevalance of osteoarthritis of the sternoclavicular joint on computed tomography. J Shoulder Elbow. 2017;26:e18–22.CrossRefGoogle Scholar
  30. 30.
    Kattahagen CJ, Tahal DS, Menge TJ, Horan MP, Millett PJ. Minimum-2-year outcomes and return to sport following resection arthroplasty for the treatment of sternoclavicular joint osteoarthritis. J Shoulder Elb Surg. 2017;26:e37–43.CrossRefGoogle Scholar
  31. 31.
    Tytherleigh-Strong G, Griffiths D. Arthroscopic excision of the sternoclavicluar joint for the treatment of strenoclavicular osteoarthritis. Arthroscopy. 2013;29:1487–91.CrossRefGoogle Scholar
  32. 32.
    Delos D, Shindle MK, Mintz DN, Warren RF. Menisectomy of the sternoclavicular joint: a report of two cases. J Shoulder Elb Surg. 2010;19(4):e9–e12.CrossRefGoogle Scholar
  33. 33.
    Tytherleigh-Strong G, Rashid A, Lawrence C, Morrissey D. Arthroscopic intra-articular disk excision of the sternoclavicular joint. Arthrosco Tech. 2017;6:e599–605.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Graham Tytherleigh-Strong
    • 1
  1. 1.Division of OrthopaedicsAddenbrooke’s Hospital, Cambridge University Hospitals TrustCambridgeUK

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