Sternoclavicular Joint Injuries | SC Joint Dislocation

The sternoclavicular joint is an important joint in the human body responsible for supporting the shoulder and upper extremities. Often referred to as the “SC” joint, this joint connects the collarbone (clavicle) to the sternum (this is the large bone that runs down the chest).  The sternoclavicular joint is the primary joint that connects the arm and shoulder to the reset of the human skeleton. Many ligaments are involved in this connection and it is these ligaments that provide the SC joint with stability.

Because of these ligaments, the SC joint remains secure and protected. The major ligaments that connect the SC joint include:

• The intra-articular disc ligament:  This particular ligament is attached to the first rib in the human body. It is a thick, strong and fibrous ligament crucial to the stability of the SC joint.
• The costoclavicular ligament:  This ligament also attaches to a rib and is located near the bottom of the SC joint. It is very strong and relatively short in length. It helps create steadiness when the SC joint is performing certain functions and/or movements.
• The capsular ligament:  This ligament provides reinforcement to the capsule that surrounds the sternoclavicular joint. It is responsible for maintaining position and keeps the sternum end of the clavicle from pointing up.
• The interclavicular ligament: This ligament resides at the top of the SC joint. It supports the ends of both clavicle bones and is positioned over the sternum, connecting one clavicle to the other.

Sternoclavicular joint injuries are relatively rare. Most people would assume that football players or gymnasts may suffer the most injuries associated with the SC joint, but in reality, traumatic accidents such as car accidents account for nearly half of all SC joint injuries.  Sports injuries only account for about 20 percent.

Types of SC Joint Injuries

Dislocations

SC joint dislocations are the most common injuries associated with the clavicle. These particular injuries cause a great deal of pain and will visibly appear as though the bone is distorted or disfigured. There are two types of sternoclavicular joint dislocations—an anterior dislocation and a posterior dislocation.  An anterior dislocation means that the clavicle is pushed forward, in front of the sternum. This is the more common injury. A posterior dislocation is less common. This injury occurs when the clavicle is pushed behind the sternum. It will take a very hard fall or traumatic event to cause a posterior dislocation and when this particular injury does occur, medical help will need to be sought immediately because vital organs reside behind the sternum, which lies against the injured clavicle. This injury can cause life threatening affects to the heart and lungs if not treated in a timely manner.

Sprains

Sprains to the sternoclavicular joint can be caused when force hits the joint.  In some cases, the joint will remain stable if the force was minor.  In moderate to more severe sprains, the joint will become unstable and will need medical treatment. Most often, patients will be put in a sling and given a regime to follow including rest, medication and light exercises.

Arthritis

When a joint has been injured, over time, even after the injury has been treated, arthritis can set in. Arthritis occurs when the cartilage around the joint decreases. Osteoarthritis is a more severe form of arthritis and will continue to get worse with age. As with any joint, the SC joint is susceptible to getting arthritis and osteoarthritis. Symptoms can be treated with medication, rest and heat. Surgical treatments are available to help treat arthritis of the SC joint.

Treatment

Non-Surgical

Treatment for sternoclavicular joint injuries will vary according to how severe the injury is. For sprains and anterior dislocations, surgery is usually not required.  If a patient has an anterior dislocation, Dr. Millett may perform a closed reduction which will involve moving the clavicle back into its normal position in the joint. This can be very painful and patients are often given general anesthesia so that the procedure can be conducted. The SC joint will need to be secured and still following this procedure. Thus, a special strap will need to be worn for a minimum of 6 weeks.

Surgical

Posterior dislocations and more severe SC joint injuries will require a thorough review by Dr. Millett using an MRI or CT scans. In some cases, reduction can be used to treat a posterior dislocation but in many cases, surgery will be needed to treat this particular injury.  Dr. Millett performs several effective surgeries to treat SC joint injuries that do not respond to conservative treatments.  Resection Arthroplasty, grafts and complete SC joint reconstruction surgeries are used depending on the case.

 You can read about two of Dr. Millett’s patients who were treated for SC joint injuries under Patient Stories.

For more information on sternoclavicular injuries or for additional resources on the SC joint and other shoulder related injuries, please contact Peter Millett, MD at his office in Vail, Colorado.

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