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The sternoclavicular (SC) joint is a small but crucial connection in your body, and injuries to it can be painful and disruptive. Before we dive in, it's helpful to know what the SC joint is and how it works. Where your collarbone (clavicle) meets the top of your chestbone (sternum) right at the base of your neck, is the sternoclavicular joint. What makes this joint unique is its structure. It's a synovial joint, meaning it's filled with fluid for smooth movement, and it has a fibrocartilage disc inside, like a mini shock absorber. This disc helps the bones fit together better and cushions impacts. Surrounding the joint are tough ligaments that provide stability, the sternoclavicular and costoclavicular ligaments. No muscles directly move the SC joint; instead, muscles like the trapezius, pectorals, and rhomboids influence it indirectly through shoulder movements. The SC allows for elevation, depression, protraction, retraction, and rotation of the arm. These motions are essential for movements like raising your arm overhead or shrugging your shoulders. Behind the joint lies vital structures like major blood vessels, nerves, the windpipe, and oesophagus; which is why severe injuries here require quick attention. Let’s have a closer look at sprains of the SC joint, and how they might happen.

How Do They Happen?

Sternoclavicular joint injuries can be categorised into grades 1 to 3. A grade 1 sprain in the SC joint is where the ligaments around it are stretched, but not torn. A grade 2 involves a partial tear of these supporting ligaments and subluxation or partial dislocation, but the joint doesn't fully dislocate. Grade 3, the highest grade of injury occurs when there is complete rupture and dislocation at the SC joint. In each case, the supporting tissues that are injured can cause pain, swelling, and instability. Fracture of the clavicle is often associated with higher grade SC joint injuries. SC joint sprains typically result from high-impact trauma, where the most common mechanism is an indirect blow, like a hard hit to the side of the shoulder that pushes the clavicle forwards or backwards. This often occurs in contact sports such as rugby, AFL, or Judo, where collisions between players, or the ground, are frequent. Upper limb weight-bearing sports; think gymnastics or martial arts where the bodyweight is supported by the upper limb; can also create instability and sprain injuries of the SC joint. Let’s have a quick look at some other mechanisms of injury:

• Motor vehicle accidents: including car crashes where the seatbelt restrains you during impact, are another major culprit.
• Falls from height: onto the front of the chest or shoulder.
• Direct blow: to the front of the chest or shoulder.
• Atraumatic sprains: no ‘big injury’, spontaneously occurring in people with loose ligaments or conditions like multidirectional instability. These might occur during overhead arm movements and are often painless at first.

What Does a Sternoclavicular Joint Sprain Feel Like?

So we can surmise that the most common mechanism of an SC joint sprain we see is usually from contact sports. Within our Spectrum family, the most common players of contact sports are our adolescent or school-aged population. Therefore, if you’re a parent reading this, or you play contact sports, here are some key indicators to be mindful of which may point to an SC joint sprain:

• Sharp pain at the joint, especially when moving your arm.
• Swelling, bruising, tenderness at the joint.
• Popping or grinding sensation (called crepitus).
• In milder cases, you might just feel stiffness or discomfort during activities like reaching overhead.
• In more severe cases, it could cause referred pain to your neck or chest.

Imaging

At Spectrum, we tend to find a thorough history and physical examination will suffice in a clean SC joint sprain. In higher-grade cases where there may be severe symptoms, deformity or risk of damage to vital structures, we may refer for imaging to confirm the diagnosis and rule out other complications:

• X-rays: usually first point of call, taken from different angles, including from front on, side on and the serendipity view (which is unique for the SC joint), to visualise joint widening or misalignment.
• CT: for more detail. CT scans provide 3D images to assess the joint, ligament integrity, and nearby structures, and it's great for telling sprains from dislocations or fractures.
• MRI: useful for soft tissue details, like ligament tears or inflammation, especially if pain persists.

How Can Spectrum Help You?

At Spectrum Healthcare, we use a range of therapies to help you get back to your best. We pride ourselves on mixing our skillset to your individual needs. In low-grade injuries, subluxations or partial-dislocations; even high-grade injuries with no fracture, conservative care is generally the appropriate first point of call. In situations where a fracture or backwards (posterior) dislocation is apparent, our Spectrum staff will organise urgent evaluation to get you the best care possible. Let's take a look at the options we have at our disposal when our care is appropriate:

• Pain Management: First and foremost, we need to reduce the pain and inflammation of the area. At Spectrum, we have some great technology including our Game Ready hot and cold therapy device, which blends the best of temperature therapy and compression.

• Manual Therapy: Next step is to get hands on. We have a myriad of techniques in this space to help you feel better: soft tissue and sports massage, dry needling, cupping, joint mobilisation and joint adjustments just to name a few.

• Rehabilitation: Once we're moving freely, it's time to get moving with some load. This step is critical in returning to our daily demands. Recall that these injuries often happen in young sports stars, so we need to ensure that the SC joint and surrounding tissues are capable and functional enough to return to the same level of demand.

• Referral: At Spectrum, we've been working with some of the best sports doctors and surgeons across Sydney. Rest assured, if the need arises, you'll be in expert hands - we wouldn't trust anything less than the best for our Spectrum family! In high-grade injuries where there may be relocation or fracture repair necessary, Spectrum will be there for your post-operative care.