Sternoclavicular Joint Pain and Instability
This article reviews sternoclavicular instability and pain. See Sternoclavicular Joint for a review of the anatomy. The sternoclavicular joint (SCJ) is inherently unstable. The main stabilisers are the strong extrinsic ligaments, and to a lesser extent the muscular envelope.
Classification of Instability
SCJ instability can be structure or non-structural, and causative factors may be traumatic, atraumatic, neurological, or a combination. Other than an acute first time event, instability may be persistent or recurrent. Dislocations are usually anterior, but can uncommonly be posterior.[1]
Stanmore's triangle system, traditionally used for describing glenohumeral joint instability, has also been used to describe SCJ instability. There are three factors that are represented as points in a triangle: type I traumatic structural, type II atraumatic structure, and type III muscle patterning (neuromuscular) non-structural. The groups exist as a spectrum, and patients can have features of two groups, and/or move to a different pattern. With type I, there is a history of trauma such as SCJ dislocation or medial clavicular fracture. In Type II there is a structural capsular pathology without a history of "macro"-trauma but there may be micro-traumatic change. In type III there is a pathological muscle-pattern with inappropriate activation of the pectoralis major clavicular and sternal parts. This is most noticeable with eccentric overhead activities. Muscle patterning can be difficult to detect.[1]
Clinical Assessment
- Posterior dislocation
- Child with medial clavicular physeal or metaphyseal fracture-separation
Resources
See Garcia et al for an open access review on sternoclavicular joint instability.[2] Also an older open access review by Sewell et al.[1]
References
- ↑ 1.0 1.1 1.2 Sewell et al.. Instability of the sternoclavicular joint: current concepts in classification, treatment and outcomes. The bone & joint journal 2013. 95-B:721-31. PMID: 23723264. DOI.
- ↑ Garcia et al.. Sternoclavicular Joint Instability: Symptoms, Diagnosis And Management. Orthopedic research and reviews 2020. 12:75-87. PMID: 32801951. DOI. Full Text.
Literature Review
Literature Review
- Reviews from the last 7 years: review articles, free review articles, systematic reviews, meta-analyses, NCBI Bookshelf
- Articles from all years: PubMed search, Google Scholar search.
- TRIP Database: clinical publications about evidence-based medicine.
- Other Wikis: Radiopaedia, Wikipedia Search, Wikipedia I Feel Lucky, Orthobullets,
