Injuries to the sternoclavicular joint are often caused by direct trauma to the collarbone area. The sternoclavicular joint, also known as the SC joint, is the bony joint that links the arm to the torso and creates the movement of the collarbone. Joint dislocations are the most common injuries to the SC joint. Displacements to the SC joint are classified as either an anterior (frontwards) sternoclavicular joint dislocation or a posterior (backwards) sternoclavicular joint dislocation.
Treatment for an SC joint dislocation will depend on the type of dislocation and the severity of the injury. The severity is classified according to the extent of the damage to the ligaments and surrounding tissue. For many anterior dislocations, a reduction can be performed where Dr. Millett will move the arm and torso around until the joint pops back into place. This procedure is typically performed under general anesthesia so that there is adequate muscle relaxation. Unfortunately, in some cases the SC joint wil remain persistently unstable and this may later necessitate surgery. For most posterior SC joint injuries, surgery is almost always required.
Post-traumatic arthritis and osteoarthritis are also conditions of the SC joint that may require surgical intervention.
Surgery Options for Sternoclavicular Joint Injuries
Dr. Millett will use a resection procedure to help treat osteoarthritis of the SC joint. This procedure involves removing some of the joint surface from the clavicle so that the arthritic bone ends do not rub and grind against each other. Resection arthroplasty is used when the SC joint has become arthritic and is effective in treating pain associated with this condition.
Reduction and Capsulorrhaphy
For certain types of acute sternoclavicular joint dislocations, Dr. Millett will perform a ‘reduction’ which is a procedure in which the clavicle is placed back into the SC joint in its proper position. If ligaments were also injured and the SC joint is unstable, then a capsulorrhaphy (repair and tightening of the ligaments) will be performed to reinforce and stabilize the SC joint. This combined effort will need to take place under general anesthesia.
SC Joint Reconstruction Surgery
In some cases, a reconstruction of the SC joint will need to take place. Dr. Millett will perform this type of surgery if the ligaments that support the SC joint are too badly damaged to repair. This is called a reconstruction because the ligaments are completely rebuilt with another piece of tissue that is taken from elsewhere in the body. A tendon graft will often be used to connect the clavicle to the sternum (breastbone) to stabilize the SC joint. A graft using a piece of tendon taken from the knee (usually from one of the hamstring tendons) will be sewn through the end of the clavicle to the sternum. This graft is effective in tightening the connection and securing the joint in place. Grafts are the preferred method for performing this procedure, especially in a posterior dislocation where the injury affects nearby organs and vessels to the head and neck. Using metal pins or wires to fix an unstable SC joint can be dangerous because these devices are at risk for puncturing nearby vital organs that reside near the SC joint.
Rehabilitation Following Surgery
After surgery is completed, Dr. Millett will provide the patient with a detailed set of rehabilitation exercises and a weekly protocol. A sling will typically need to be worn for a minimum of 6 weeks, and therapy will commence at the appropriate time so that range of motion and strengthening can return.