Surgical Anatomy of the Sternoclavicular Joint

Disability following injury to the sternoclavicular joint can range from pain, deformity, and discomfort to devastating neurovascular complications . Sternoclavicular pathology can be inflammatory or degenerative but is typically due to a direct blow or indirect force transmitted from the shoulder. The injury pattern is predominantly either an anterior or posterior dislocation with some degree of associated ligamentous, disc, or cartilage damage.

The ligamentous structures that stabilize the sternoclavicular joint are the posterior sternoclavicular ligament, the anterior sternoclavicular ligament, the costoclavicular ligament, the inter-clavicular ligament, and the intra-articular discoligamentous complex . Several authors have proposed that the costoclavicular ligament is the predominant stabilizer of the sternoclavicular joint. However, other biomechanical data suggest that the posterior sternoclavicular ligament is the primary stabilizer.

Although some anterior sternoclavicular joint dislocations can be treated nonoperatively, reduction and stabilization of posterior sternoclavicular joint injuries is necessary as they can cause catastrophic injury to the underlying mediastinal structures. Surgical reconstruction requires posterior dissection of the clavicle and a blind posterior dissection of the manubrium. The mediastinal vasculature is, on average, 6.6 mm deep from the posterior aspect of the sternoclavicular joint. Just anterior to the mediastinal vessels reside the strap muscles, and these muscles could provide some protection during posterior sternoclavicular joint dissection. Other muscles inserting around the sternoclavicular joint include the pectoralis major, sternocleidomastoid, and subclavius muscles. The anatomical locations of the muscle insertions at the medial end of the clavicle and at the manubrium are not well defined.

Currently, a paucity of information exists regarding the quantitative anatomy of the sternoclavicular joint. The purpose of this study was to define the sternoclavicular joint anatomy, to quantify the ligament and muscle-tendon insertions surrounding the sternoclavicular joint, and to define pertinent osseous landmarks, which can serve as reproducible anatomical landmarks during sternoclavicular joint surgery.

Full Article: Surgical Anatomy of the Sternoclavicular Joint

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

Submit your review
Name:
Email:
Website:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel

Surgical Anatomy of the Sternoclavicular Joint

About the Author: Peter Millett, MD