Sternoclavicular Joint Disorders

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Clinically Relevant Anatomy

The Sternoclavicular (SC) joint is the only bony joint that connects the axial and appendicular skeletons. The SC joint is a plane synovial joint formed by the articulation of the sternum and the clavicle. Due to the joint’s articulation between the medial clavicle and manubrium of the sternum and first costal cartilage, the joint has little bony stability. Between the medial clavicle and manubrium is a dense fibrocartilaginous disc that separates the joints into two distinct synovial compartments. The intra-articular ligament provides joint stability and prevents medial displacement of the clavicle. This ligament originates from the junction of the first rib and sternum and passes through the SC joint and attaches to the clavicle on the superior and posterior side. The anterior and posterior sternoclavicular ligaments restrain anterior and posterior translation of the medial clavicle. The anterior and posterior sternoclavicular ligaments originates on the anterior and posterior ends of the clavicle, respectively, and inserts onto the anterior and posterior surfaces of the manubrium, respectively. The SC joint is supported superiorly by the interclavicular ligament that connects the superomedial portions of each clavicle. The blood supply to the SC joint is from the articular branches of the internal thoracic and suprascapular arteries. The SC joint is innervated by the branches of the medial suprascapular nerve. The brachiocephalic trunk, common carotid artery, and the internal jugular vein all lie directly posterior to the SC joint.

Mechanism of Injury / Pathological Process

Patients with SC joint dysfunction can be classified into two categories based of the mechanism of injury: traumatic or atraumatic.

Traumatic
Traumatic injuries to the SC joint range from minor subluxation to complete dislocations. Injuries to the SC joint are rare and infrequently seen in physical therapy. Full dislocation of the SC joint is rare due to the large amount of force and specific vector required to displace the joint. Typically, traumatic injuries to the SC joint occur during: falls, sports-related injuries or vehicular accidents. Anterior SC joint dislocations are more common,. Posterior dislocations have serious clinical implications as the surrounding nerves and vessels may be compromised.

Atraumatic
The SC joint is vulnerable to the same disease processes than occur in joints such as degenerative arthritis, rheumatoid arthritis, infections, and spontaneous subluxation of the joint. A thorough history is required to determine the presence of non-musculoskeletal disorders.

Clinical Presentation

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Diagnostic Procedures

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Outcome Measures

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Management / Interventions

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Differential Diagnosis

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Key Evidence

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