Sternoclavicular Joint (SJ) Injury: Causes, Treatment and Exercises
The sternoclavicular (SC) joint is one of several joints that make up the shoulder complex. It is the link between the clavicle (collar bone) and sternum (breast bone), attaching the shoulder to the front body. The SC is well supported by ligaments both within and surrounding the joint. This joint also has significant mobility to allow for movement of the upper limb but is well supported and designed for stability.
The only articulation between the upper limb and axial skeleton, the SC joint seems at risk for injury. However, injuries to this joint are actually uncommon and require an accident with a lot of force. Injury can range from sprains up to dislocations of the SC joint or indirectly a fracture of the clavicle.
The extent of the injury can be classified by stages:
Stage 1: Sprain – ligaments intact
Stage 2: Subluxation – sternoclavicular ligaments torn but costoclavicular ligaments intact
Stage 3: Dislocation – tearing of all ligaments
There are two classifications of dislocation: anterior and posterior indicating the direction the clavicle head moves. Posterior dislocations are considered the more urgent of the two, as the clavicle could be impinging or pressing on vessels or vasculature of the chest cavity. This type of injury may require surgical intervention.
What Causes a SC Joint Injury?
SC joint injuries are mainly seen in MVA and sports settings due to collision or impact, often occurring when a player is hit on the shoulder from behind or the side such as during a tackle. A sprained SC joint may follow as the result of such a high-energy situation but it is also possible to sprain the joint due to laxity of ligaments of instability in the joint.
A dislocation injury of the SC joint may result from direct impact or indirect impact, such as a fall on an outstretched hand. The resulting force is transmitted from the hand, up the arm and into the clavicle. In the majority of cases this commonly results in fracture of the clavicle leaving the SC joint intact. This is due to the strength and stability of the SC joint, which has both articular cartilage that acts as a shock absorber and strong fibrous ligaments acting to protect it. In the rare occurrence of dislocation in this joint it is often seen in patients younger than 25.
What are Symptoms of a SC Joint Injury?
Depending on the severity of injury symptoms might include:
- shoulder pain
- pain in the clavicle or sternum
- a bump or a divot where the clavicle meets the sternum
- difficulty with arm movements
- if more emergent symptoms such as difficulty in breathing and swallowing which may indicate a posterior dislocation
How can Physiotherapy, Chiropractic and/or Massage Therapy Treatment Help with SC Joint Injuries?
If you suspect you have an SC joint injury it is important to seek a professional assessment. A physiotherapist, massage therapist or chiropractic assessment will determine the proper course of treatment to help your SC joint feel strong and stable again. Their assessment will help determine the proper course of treatment personalized to your injury and needs. They may refer you to your doctor for an exam and potential imaging to help determine the extent of the injury.
Treatment of this condition may involve immobilizing the joint for 2-8 weeks depending on the extent of the sprain, you may be asked to wear a sling to restrict movement and allow for healing. Our rehab team will help provide manual therapy and massage of the surrounding muscles and joints to normalize their position and function. Following a specific strengthening program that will target muscle weaknesses and imbalances helping to improve muscle control and activation around the joint and in the upper extremity as a whole.
What are Safe Home Exercises for SC Joint Injuries?
The type and classification of SC joint injury will determine the best exercises for your stage of rehabilitation.
Looking to have a pain free range of motion before strengthening is a good guideline and avoiding overhead movements until cleared by your physiotherapist. The following exercises are commonly given in the early stages of rehabilitation and should be performed pain free.
- While standing with your arms at your sides, squeeze your shoulder blades together. Do not raise your shoulders as you are squeezing.
- Hold 6 seconds.
- Repeat 8 to 12 times.
Shoulder Flexion (lying down)
- Lie on your back, holding a broomstick with your hands. Palms face down with hands slightly wider than your shoulders.
- Keeping your elbows straight, slowly raise your arms over your head until you feel a stretch in your shoulders, upper back, and chest.
- Hold 15 to 30 seconds.
- Repeat 2 to 4 times.
Shoulder Extension (standing)
- Stand, and hold a broomstick in both hands behind your back. Place your hands wide enough apart on the stick so it is comfortable and about the same width as your shoulders. Your palms should face away from your body.
- Move the broomstick back away from your body. Go as far as possible without pain.
- Hold the stretch for about 6 seconds.
- Repeat 8 to 12 times.
If you are suffering from Sternoclavicular Joint injury and would like to see one of our experienced physiotherapists, chiropractors or registered massage therapists, please book an appointment online or contact us today.
Rebalance Sports Medicine is a multidisciplinary clinic in downtown Toronto offering physiotherapy, chiropractic, registered massage therapy, sports medicine, naturopathy, Pilates and more.