Sternoclavicular Joint Injuries: Clinical Features, Classification, Treatment and Complications

Sternoclavicular joint connects the sternal end of the clavicle with the clavicular notch of the sternum and it is stabilized by many ligaments
Sternoclavicular joint injuries are uncommon, and mostly caused by trauma (e.g. lateral compression of the shoulder during RTA and crush injuries) or it can also be atraumatic due to ligamentous laxity
Some of these injures are dangerous, there might be damage done to mediastinal structures lying behind the clavicle

Classification

sternoclavicular joint injuries are classified into
- Sprains and subluxations
- dislocations (anterior or posterior)
- Physeal fracture in patients younger than 25 years old (Salter-Harris type 2)
Anterior dislocations of SC joint is more common than posterior dislocation

in sternoclavicular joint sprains and subluxations, Patient complain of pain at the joint area
in sternoclavicular joint anterior dislocations, then:
- the dislocated clavicle forms a prominent swelling on the SC joint
- Patient complain from pain at the joint
- There are usually no damage to mediastinal structures with anterior dislocation
in sternoclavicular joint posterior dislocations, then:
- Posterior dislocation is dangerous, dislocated medial clavicle might pressure trachea causing dyspnea or might pressure large vessels causing venous congestion of the neck and arm or it may pressure esophagus causing dysphagia (look for these findings)
- Patient also complain from pain at the joint area

Sprains and subluxations do not require specific treatment other than sling for comfort and return to unrestricted activity by 3 months
Anterior dislocation can be reduced by putting pressure on the clavicle while pulling on the arm with the shoulder abducted, full function might take several months to return
Re dislocation is common
Internal fixation is usually unnecessary and potentially dangerous (large vessels are lying close behind the sternum and might be injured)
Posterior dislocation should be reduced, reduction is done closed (GA might be used), patient in supine position with sandbag between scapulae and then arm is pulled with shoulder abduction and extended, joint reduce with a snap and stay reduced
If this fails => medial end of the clavicle is grasped by bone forceps and pulled but if failed => open reduction is done (care taken not to damage mediastinal structures)
After reduction in both types (anterior and posterior dislocations) shoulders are braced with a figure of eight bandage for 3 weeks