Injuries to the sternoclavicular (SC) joint are uncommon given the large energy vector required to disrupt its ligamentous stabilizers. In fact, it is one of the least commonly disrupted joints in the body. Because of the high-energy mechanism required to violate this articulation, the presence of concomitant injuries is not uncommon and may lead to missed diagnoses. Although SC joint injuries account for only 3% of all shoulder girdle injuries and 1% of all dislocations, consequences of such an injury can be devastating because of the close proximity of cardiopulmonary structures, especially in posterior dislocations. Therefore, it is critically important for the practitioner to conduct a full survey of the patient to establish priorities for treatment in the acute setting.
It has been well-documented that long-term sequelae after an acute dislocation treated nonoperatively may result in painful degenerative changes within the SC joint over time. Thus, patients may present years after the initial injury with painful arthritis of the SC joint, seeking a surgical solution.
Numerous techniques have been described for the treatment of the unstable or degenerative SC joint. In general, SC joint instability is treated by stabilization procedures with suture anchors, plates, or tendon grafts. Arthritis of the SC joint is typically treated with open excision of the medial clavicle, although newer arthroscopic techniques are available. However, because these injuries are rare and prior clinical studies have only reported on small numbers of injuries, there still does not exist an accepted standard for surgical treatment.
The purpose of this article is to provide an updated review on the diagnosis and management of instability and degenerative arthritis of the SC joint.