<p>Sternoclavicular Joint Instability: Symptoms, Diagnosis And Management</p>

Abstract

Sternoclavicular joint (SCJ) instability is a rare condition and results from either a traumatic high energy impact, such as a motor vehicle crash or contact sports injury, or nontraumatically as a result of structural pathology. The infrequency of this injury has contributed to its diagnosis being missed as well as the paucity of literature on treatment and outcomes. Patients with SCJ instability often report diminished range of motion as well as shoulder girdle pain. The presentation of instability in the sternoclavicular joint can vary in severity and anterior or posterior directionality. Variation in severity of the instability changes the course of treatment regarding either operative or non-operative interventions to stabilize the SCJ. In general, anterior instability of the SCJ (the medial clavicle is displaced anterior to the sternum) is less urgent and generally manageable by symptom alleviation and rehabilitation, although some anterior instability cases require surgical intervention. In the case of posterior SCJ instability (the medial clavicle is displaced posterior to the sternum), patients require prompt joint reduction as they are at the greater risk of life-threatening injury due to the location of critical structures of the mediastinum posterior to the SCJ. Computed tomography visualization is useful to confirm dislocation or subluxation direction to better formulate a proper treatment plan. The purpose of this review is to report the clinical presentation and management of SCJ instability including pertinent symptoms, the diagnostic approaches to evaluating SCJ instability, as well as operative and non-operative management of the joint instability.

Superior sternoclavicular joint dislocation presented with shoulder motion limitation: A case report and literature review

“…The sternoclavicular joint is the only synovial joint connecting shoulder girdle to the upper trunk [ 1 ]. The special shape of the medial clavicle (concave from front to back and convex from top to bottom) gives the sternoclavicular joint its saddle shape and provides the joint with ability to move in three planes (elevation/depression, protraction/retraction, rotation) [ 2 ] ( Fig. 5 ).…”

“…The study of Spencer et al demonstrated that the joint capsule stabilizes the joint against anterior/posterior subluxation [ 10 ]. Meanwhile, the costoclavicular ligament and intraarticular disc prevents the medial clavicle from upward and medial displacement respectively [ 2 ].

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“…The injury may be missed due to its low incidence. Also, possible associated injuries may distract the physician from examining the sternoclavicular joint [ 2 ]. However, its early diagnosis is important as posteriorly dislocated sternoclavicular joint may compress the adjacent mediastinal structures (e.g.…”

Morphologic Alterations of the Sternoclavicular Joint following Ipsilateral Clavicle Fractures

“…It allows for the guided lifting, lowering, and forward and backward movement of the shoulder, as well as its circumduction. Injuries of the SCJ are rare [ 1 ] and can be easily missed in the primary survey of a patient, especially in those who are polytraumatized [ 2 , 3 ]. SCJ injuries are clinically categorized into three stages: sprain, subluxation, and dislocation [ 4 ].…”

“…Anterior dislocations or subluxations of the SCJ are more common than posterior dislocations and can result in functional impairment [ 6 ]. In the case of anterior subluxations and dislocations, the treatment may include reduction and rehabilitation, though some instances may require stabilization through surgical intervention and management [ 3 , 6 ].…”