Sternoclavicular Joint Strain | Shoulder Surgeon, Bangalore

The sternoclavicular (SC) joint is one of the four joints that complete the shoulder. This joint is located in the area where the collarbone meets the sternum at the base of the neck. The SC joint is generally classified as a plane style synovial joint and has a fibro-cartilage joint tissue. The sternoclavicular joint is responsible for providing adequate support to the shoulder joint. It is also the main connection between the shoulder and arms. The ligamentous reinforcements of this joint are very strong, often resulting a strain of the joint. Although not common, sternoclavicular strain can arise from injury and other disorders.

Strain to the sternoclavicular joint typically results from motor vehicle accidents or participation in collision sports like football, rugby etc. While these injuries can be painful, most are relatively minor and will heal well without surgery. Very rarely, a hard blow to the sternoclavicular joint can damage the vital organs and tissues that lie nearby. When this occurs, it is a serious injury that goes beyond a strain and requires immediate medical attention.

The sternoclavicular joint can also be damaged over time, as the protective tissue that covers the ends of the bones gradually wears away. This type of degenerative change in the joint can lead to pain, stiffness, and reduced motion in the shoulder and arm.

Let’s delve a bit deep into the sternoclavicular strain.

What is sternoclavicular strain?

A sternoclavicular strain is an injury to the sternoclavicular joint and it is often referred to as shoulder strain. However, shoulder strains can affect various structures within the shoulder joint. A sternoclavicular joint strain is a distinct injury that is not as common as other strains that can occur within the joint. A sternoclavicular strain generally happens when chest makes impact with an object or force. These injuries require a lot of force such as tackle in football or rugby (especially the player is struck on the back or side of the shoulder) or hitting the steering wheel during an automobile accident. A sternoclavicular joint strain involves a tear of the muscles that constitutes this area of the shoulder. A sternoclavicular strain, if severe, can dislocate the shoulder. The clavicle can be dislocated forwards or backwards with regards to the sternum. Clavicle dislocating backwards can be very dangerous, as blood vessels, nerves, the trachea (windpipe), and the esophagus are located behind the clavicle and sternum.

Symptoms of sternoclavicular strain:

A sternoclavicular strain may induce a sudden pain in the sternoclavicular joint area. Pain is predominantly present when the arm is lifted overhead, moved across the body or when lifting objects. If the strain is severe, the patient may not be able to do activities of daily living. Patient can experience swelling, bruising etc. Other prominent symptoms of a sternoclavicular joint strain are the following:

Shoulder pain
Clavicle or sterna pain
A bump at the site of joint between the clavicle and sternum
Difficulty breathing
Difficulty swallowing

Diagnosis of sternoclavicular strain:

People or athletes with a suspected sternoclavicular strain are evaluated by a physician. A physician or a sports medicine specialist will perform a thorough history and physical exam to zero in on the source of the pain. Often x-rays are done, but to evaluate the full extent of the injury, further testing like a computed tomography (CT) scan or magnetic resonance imaging (MRI) may be ordered. These scans can help determine the intensity of the sternoclavicular strain and rule out any other injuries to the shoulder joint.

Treatment for sternoclavicular strain:

For an SC strain, treatment may include icing, inflammation and/or pain control with medications. In the unlikely event, if there is dislocation, treatment depends on which direction the clavicle is dislocated. If the clavicle is dislocated forward, trying to put it back is the first-line of treatment. Generally, this injury can be satisfactorily treated with a sling or a brace. However, if the clavicle is dislocated backwards, an operative intervention is the way out. This is often the case in instances where an athlete experiences difficulty breathing and warrants to be managed as a true emergency.

Sternoclavicular injury prevention:

Unfortunately, there is nothing specific a sportsman or general public can do prevent an SC strain. As for sports people, being well trained and conditioned in order to be best prepared for safety and success in the sport of their choosing is a sensible thing to do. People participating in contact sports would likely benefit from exercises designed to enhance shoulder and chest wall strength.

Returning to sports after a sternoclavicular strain:

An athlete can resume his/her sporting activities when the pain is under control and strength and range of motion is normal in the arm on the affected side. Adequate time to allow the SC joint to recuperate is necessary to prevent long-term complications like pain and instability. The time required to recover from an SC joint strain varies from person to person, depending on the intensity of the strain to an extent. A quality rehabilitation program post sternoclavicular joint strain would improve the overall recovery process.

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Q&As on Sternoclavicular Joint Separation

1) What are the different grades of Sternoclavicular Joint Separation?

The different grades of sternoclavicular joint separation are:

Grade I: A simple strain, also known as a grade I sprain, is characterised by an incomplete rupture or straining of the sternoclavicular and costoclavicular ligaments. Grade I injuries are the least severe.
Grade II: A complete rupture of the sternoclavicular ligament and a partial rupture of the costoclavicular ligament is included in the diagnostic criteria for a grade II injury.
Grade III: A complete rupture of the sternoclavicular and the costoclavicular ligaments is referred to as grade III sternoclavicular joint separation.

2) What is Sternoclavicular Joint Separation?

Your collarbone and breastbone are connected at the sternoclavicular joint, which is situated in the middle of your upper chest. A sturdy ring of tissue known as a ligament holds these bones together. Your collarbone and breastbone may become separated if the ligament stretches or rips.

The most frequent reason for a sternoclavicular joint separation is a direct blow to the breastbone or collarbone. A fall onto your shoulder or extended hands, which applies pressure to your collarbone, might also be the reason.

3) How is Sternoclavicular Joint Separation diagnosed?

Diagnosis of sternoclavicular joint separation can be done in the following ways:

Medical history and symptom review: The doctor will inquire about the patient’s symptoms, medical background, and general health.

Physical examination: The healthcare professional will inspect the injury site for abnormalities, discomfort, and other symptoms, assess the arm’s range of motion, and evaluate if the hand and fingers are receiving enough blood flow. The medical professional could advise the patient to pick up a weight to testify to make the deformity more apparent.

Imaging research: For injuries to the AC joints, standard X-rays are usually sufficient, but additional imaging techniques like CT or MRI scans may be needed to diagnose injuries to the SC joints.

4) How can Sternoclavicular Joint Separation be prevented?

Sternoclavicular joint separation injuries can be prevented by managing:

Sports and mishaps: Appropriate safety measures and gear should be used to lower the chance of these injuries, whether riding a bicycle, driving by car, or engaging in contact sports. This includes the usage of seat belts, helmets, padding, and guards, among other items.

Falls: Hard falls are more frequent in contact sports, and older individuals or those with osteoarthritis may sustain injuries from lighter falls. Maintain a clutter-free home and build railings and guardrails to reduce the chance of falling.

Osteoarthritis: As individuals age, osteoarthritis may be delayed by leading a healthy lifestyle. To reduce the risk, maintain a healthy weight, manage blood sugar, engage in regular physical activity, and remain injury-free.

5) How is Sternoclavicular Joint Separation treated?

Different treatments for sternoclavicular joint separation are:

Non-surgical management: If the SC joint damage is minimal, non-surgical therapy could be sufficient to alleviate the symptoms. Medication for discomfort, using a sling to keep you immobile, or applying cold packs are all possible treatments.

Closing reduction: Without surgery, the medical professional could attempt to realign the clavicle in cases with SC joint dislocation. The typical setting for this non-surgical procedure is the operating room, where it may be necessary to provide muscle relaxants or general anaesthesia.

Operative procedure: Surgery for SC joint injuries may be required if pain or abnormalities are severe. Surgery is more likely to be necessary if the joint is dislocated.