Sternoclavicular Separation

Brief Outline of Sternoclavicular Separation

Sternoclavicular separation occurs when a ligament connecting the collar bone or clavicle to the breastbone or sternum is torn. Rotation at the joint is affected by this injury, which may occur during contact sports when the shoulder forcefully strikes the ground or is landed upon by another player. The separation may occur anteriorly or posteriorly (in front of or behind the breastbone).

Sternoclavicular Separation

Anatomy and physiology

The sternoclavicular (SC) joint is functionally a ball-and-socket joint, but unlike most articular surfaces, the articular cartilage is fibrocartilage rather than hyaline cartilage. The SC joint is surrounded by a joint capsule, thickened anteriorly and posteriorly by: the posterior sternoclavicular ligament, the anterior sternoclavicular ligament, the costoclavicular ligament, and the interclavicular ligament. The sternoclavicular joint is strong and generally resistant to dislocation, and has a wide range of movement.

Sternoclavicular Anatomy

Cause of Sternoclavicular Separation

Direct blow to the sternum. Fall onto the shoulder or outstretched hands. Shoulder striking the ground, or another athlete landing on top of the shoulder.

Signs and symptoms

Pain, swelling, and tenderness over the sternoclavicular joint. Abnormal movement between the breastbone and the collar bone. Possible displacement of the collar bone in front of or behind the breastbone.

Complications if left unattended

Untreated sternoclavicular separation can lead to loss of motion and ongoing pain, stiffness, and weakness. Furthermore, in cases where the collar bone is forced behind the breastbone, a risk exists for damage to the underlying blood vessels in the chest or the heart, requiring surgical intervention.

Treatment

  • Reduction of the joint is needed
  • Immobilisation

Rehabilitation and prevention

As the injury is generally caused in a sports accident, prevention is usually not possible. In the case of anterior injury to the sternoclavicular joint (the most common), the condition is generally resolved without permanent complication, following adequate healing time. In more severe cases, surgery may be required. Range of motion exercises should help restore movement and rotational ability.

Long-term prognosis

With adequate time for healing, the injured athlete typically makes a full recovery. If the injury is serious (particularly in the case of posterior dislocation) instability of the joint may persist, in some case requiring surgery.

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