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.

Call (+65) 6471 2674 (24 Hour) to fix an appointment to treat your sternoclavicular separation today.

Brief Outline of Acromioclavicular Separation

Acromioclavicular separation is a separation of the ligaments that connect the clavicle (collar bone) to the shoulder bones (known as theĀ acromion process). Acromioclavicular (AC) joint injuries generally occur in the course of upper-extremity strength training, various throwing sports, and collision sports (particularly, football and hockey). The injury is common among athletes in their 30’s and 40’s.

 

AC Joint Dislocated

Anatomy and physiology

The arm is linked to the axial skeleton by means of the acromioclavicular joint, which connects the lateral end of the clavicle, and the medial border of the acromion of the scapula. A fibrocartilage articular disc partially divides the articular cavity, and absorbs forces and compression in the acromioclavicular joint is stabilised by anterior deltoid muscle, the trapezius muscle arising from the acromion, and additionally, by stabilising ligaments.

Cause of Acromioclavicular Separation

Fall onto the point of the shoulder. Fall onto an outstretched hand. Direct blow to the shoulder.

Signs and symptoms

Pain, tenderness, and swelling at the AC joint. Deformity of the injured joint. Pain or discomfort during cross-body adduction (turning the injured arm inward toward the opposite shoulder).

Complication if left unattended

Degenerative joint abnormalities, chronic pain and stiffness and limitations in mobility requiring surgery are possible, should the condition not be given prompt medical attention and allowed proper healing time.

Treatment

Immobilisation of the injured arm with a sling.

Rehabilitation and prevention

AC separations of a less severe nature are successfully treated without surgery, though a thorough healing period of 6-8 weeks us generally required, following which, range-of-motion exercises should be used to avoid stiffness. Exercises directed at maintaining strength and stability of the shoulder and upper back muscles may help prevent the injury and use of padding around the AC joint, particularly during contact sports, may help avoid re-injury.

Long-term prognosis

Given adequate healing time and rehabilitation, most AC separations are resolved without surgery. Should surgery be required, risks of infection and continued pain exist, and recovery time for the athlete is lengthened.

Call (+65) 6471 2674 (24 hour) to fix an appointment to see our doctor regarding your AC separation today.