The Sternoclavicular Joint, abbreviatedSC joint, is a triaxial synovial joint formed from the medial end of the Clavicle and the Clavicular facet on the Sternum . This represents one of five joints/ functional articulations that form The Shoulder Girdle and the only skeletal articulation between the upper limb and the axial skeleton. The joint therefore, plays a subtle yet integral role in motion of the arm.
Articular Disc
Anterior and Posterior Sternoclavicular Ligaments
Medial Supraclavicular Nerve - innervates superficial joint capsule
Nerve to Subclavius - innervates deep joint capsule
By Region
Continuities
Although relatively small, the Sternoclavicular Joint represents the primary skeletal connection between the upper limb and axial skeleton (SOURCE-5). It is a saddle-shaped, synovial joint whose surface is concave vertically while convex horizontally (on an anteroposterior axis) (SOURCE-3+5). This joint architecture is unstable, with less than 50% of the articular surface of the medial Clavicle corresponding with the Manubrium of Sternum (SOURCE-7). The lack of full articular congruency and limited contact increases the need for passive and dynamic stabilisers (SOURCE-2+4+5+7+8):
Intraarticular Fibrocartilaginous Disc - spans from the superoposterior portion of the Clavicle ’s articular surface to the First Costal Cartilage near the Sternal Junction, accounting for ~60-75% of the medial Clavicle. The discs remaining circumference lends fibres to the joint capsule and Sternoclavicular Ligaments. While the disc in its entirety is described as fibrocartilaginous, there appears to be two distinct sides that reflect its function. The sternal side of the disc is comprised of a dense Connective Tissue through the presence of fusiform Fibroblasts . The Clavicular side comprised of fibrocartilaginous tissue due to the presence of round Chondrocytes, suggesting this side functions to withstand the compressive forces of loading
Sternoclavicular Joint Capsule - a major stabiliser, particularly along an anterior-to-posterior axis. The Posterior Capsule is postulated by some to be the strongest passive stabiliser as its sectioning resulted in the greatest joint displacement
Anterior and Posterior Sternoclavicular Ligaments - indistinct thickenings of the joint capsule which restrict medial Clavicle movement in an anterior, posterior and superior direction
Interclavicular Ligament - attachment between the superior surface of both medial Clavicles, forming a bridge over the Manubrium. Affords stability, particularly against depression of the Clavicle
Costoclavicular Ligament - provides indirect but significant support in all directions except clavicular depression by linking the inferior surface of the Clavicle with the First Ribs
Sternocleidomastoid - the Clavicular Head makes its insertion on the superior surface of the medial Clavicle via a thin broad tendon while its Sternal Head inserts on the superior Manubrium via a round tendon. The Sternal Head courses anteriorly of the Sternoclavicular Joint, which affords additional support
Pectoralis Major - makes attachment on a superoanterior portion of the medial Clavicle known as theClavicular Pectoralis Ridgevia a thin Tendon that is as wide as the muscles clavicular origin
Subclavius - a long origin from the inferior Cartilage of the Clavicle that courses obliquely towards the lateral First Ribs costal cartilage. Contraction of the Muscle depresses and stabilises the Clavicle. This is thought to help prevent upwards displacement/ Dislocation when the lateral Clavicle is subjected to compressive forces
Sternohyoid - the majority of the muscles distal attachment is made on the medial Clavicle with a portion also extending to the posterior Sternoclavicular Joint Capsule
Sternothyroid - a more distal insertion compared to the Sternohyoid , attaching to the posterior Sternum and Costal Cartilage
Fascia l Attachment - a fascial continuity extends between sides of the Sternohyoid and Sternothyroid with a thickening at the midline that attaches to the posterior Manubrium. Anterior of this layer is known as a “safe zone” as it contained no vascular structures
The aforementioned attaching Muscles not only afford stability but influence its overall mechanics and possible injury (SOURCE-1+2+6).
The Clavicle has 3 degrees of freedom, each correlating with a plane of movement (sagittal, frontal, horizontal) (SOURCE-3). Due to relative capsule laxity, greater motion is permitted between the Clavicle and disc rather than the Sternum (SOURCE-4). All movements of The Shoulder Girdle correspond with movement of the Clavicle at the Sternoclavicular Joint, for example the Clavicle elevates ~4º for ever 10º of GH Joint - Flexion (SOURCE-7). Specific movement patterns available to the Sternoclavicular Joint are detailed below:
Elevation- of the medial Clavicle at the Sternoclavicular Joint about a slightly oblique anterior-to-posterolateral axis where its convex surface rolls superiorly and glides inferiorly on the articular disc and Manubirum of Sternum to maintain joint contact (SOURCE-3+8). Upper Fibres of the Trapezius lift the lateral Clavicle while the Levator Scapulae indirectly contributes through elevation of the Scapula (SOURCE-3). Rhomboids serve as dynamic stabilisers while passive stability is afford by the Costoclavicular Ligament (SOURCE-3+8). Rather than the joints centre, this taught ligament acts as the pivot point for movement; a subtlety which causes the motion at one end of the Clavicle to oppose the other (SOURCE-8). Up to 45º of elevation is typically available which roughly translates to 10cm (SOURCE-8). There is approximately 10º of elevation at the Glenohumeral Joint for every 4º of elevation at the Sternoclavicular Joint (SOURCE-8). Motion at the Sternoclavicular Joint is also closely related to Scapulothoracic Joint - Elevation
Depression- of the medial Clavicle at the Sternoclavicular Joint about a slightly oblique anterior-to-posterolateral axis where its convex surface rolls inferiorly and glides superiorly on the articular disc and Manubirum of Sternum to maintain joint contact (SOURCE-3+8). As depression is an eccentric movement, gravity and relaxation of SC Joint - Elevation muscles are large contributors to the movement. Active or full depression is facilitated through a concentric Muscle Contraction of the Subclavius which pulls inferiorly on the Clavicle, the Pectoralis Minor and Levator Scapulae which depresses through the Scapula and larger muscles such as the Pectoralis Major and Latissimus Dorsi which depress The Shoulder Girdle (SOURCE-8). The fully depressed Clavicle elongates the Interclavicular Ligament and superior portion of the Capsular ligaments which afford passive stability (SOURCE-8). Additionally the Posterior Lamina of the Costoclavicular Ligament is pulled taught which not only affords stability but acts as the pivot point for movement, rather than the joints centre (SOURCE-8). This subtlety causes the motion at one end of the Clavicle to oppose the other (SOURCE-8). A total of 60º is typically available to the medial Clavicle through the elevation-depression arch which translates to roughly 10cm of elevation and 3cm of depression at the lateral Clavicle (SOURCE-8). Depression at the Sternoclavicular Joint is intimately tied to Scapulothoracic Joint - Depression
Protraction- of the Medial Clavicle at the Sternoclavicular Joint occurs about a vertical axis of rotation as the concave articular surface of the Clavicle rotates and glides anteriorly (SOURCE-3). These arthrokinematics occur during a forwards reach with the upper limb, with 15-30º of movement typically available (SOURCE-3). The end ranges of Clavicular Protraction are limited by the Posterior Glenohumeral Capsular Ligaments , Posterior Costoclavicular Ligament and Scapulothoracic Joint - Retraction Muscles (SOURCE-3). This movement is coupled with Scapulothoracic Joint - Protraction (SOURCE-3)
Retraction - of the Medial Clavicle at the Sternoclavicular Joint occurs about a vertical axis of rotation as the concave articular surface of the Clavicle rotates and glides posteriorly (SOURCE-3). These arthrokinematics occur as The Shoulder Girdle is retracted/ pulled backwards, with 15-30º of movement typically available (SOURCE-3). Clavicular Retraction is limited by the Anterior Costoclavicular Ligament and Anterior Glenohumeral Capsular Ligaments (SOURCE-3). This movement is coupled with Scapulothoracic Joint - Retraction (SOURCE-3)
Axial Rotation - posterior rotation of the Clavicle occurs as the arm is elevated and Scapula Upwardly Rotated. During this motion the Coracoclavicular Ligament is pulled taut, drawing on the posteriorly situatedConoid Tubercleof Clavicle and causing it to rotate posteriorly about its longitudinal axis (SOURCE-3). Arthrokinematics involve a spin of the Clavicular Head about the lateral surface of the articular disc (SOURCE-3). Full posterior rotation is considered the joints close-packed position, with approximately 40-50º of rotation typical (SOURCE-3+4+9)
The closed-packed position where the joint is most stable (maximal joint surface contact/ ligament tension) is achieved through full posterior rotation of the Clavicle and Scapulothoracic Joint - Upward Rotation , as seen when the arm is elevated overhead (SOURCE-4). This motion pulls taut the Anterior Sternoclavicular Ligaments and Anterior Costoclavicular Ligament , producing a Sternoclavicular Posterior Glide (SOURCE-4).
With injury to the Sternoclavicular Joint considered rare, it is more often attributed to traumatic onset rather than pathological states of Inflammation or degeneration (SOURCE-2+6). The most common mechanism of trauma is either indirectly through The Shoulder Girdle (in particular a lateral blow while in GH Joint - Extension ) or through a direct blow to the Sternoclavicular Joint which is estimated to account for the remaining 10-25% (SOURCE-2+6). Typically this results in Dislocation and associated damage to the ligament , disc or Cartilage (SOURCE-6).
Due to limited articular contact the Sternoclavicular joint is inherently unstable, with damage such as a Sprain to the aforementioned ligaments leading to instability and consequent Subluxation or Dislocation (SOURCE-2). A sprain should not be assocaited with any joint laxity or instability while a Subluxation suggests Tear ing of the Sternoclavicular Ligaments and intact Costoclavicular Ligaments (SOURCE-5). This forms the basis for the classification of Sternoclavicular Joint injury where Type-I is considered a sprain, Type-II a Subluxation and Type-III a Dislocation where both Sternoclavicular and Costoclavicular Ligaments are compromised (SOURCE-5). While in the elderly the disc is typically subject to degeneration, the young may also expereince tears which may be an additional source of Pain (SOURCE-7). Chronic Sternoclavicular Instability is rare but may result following ineffective diagnosis or treatment (SOURCE-2)
Sternoclavicular Dislocations can occur in either an anterior or posterior direction and are estimated to account for a total 1-3% of all dislocations (SOURCE-2+5+6):
Anterior Dislocation - more common and typically identifiable by a bony prominence. Pain may be localised to the joint with instability and decreased Shoulder Range of Motion also likely. With traumatic onset local bruising or oedema may also be present
Posterior Dislocation - less common and less apparent upon examination but potentially more severe, with the capacity to affect The Lungs , Trachea, Oesophagus or mediastinal neurovascular structures. Similarly to anterior dislocations local Pain may be present; however, a visible depression may be masked by Inflammation . Although rare, assessment of the underlying mediastinal structures is crucial as they may be compressed
In the young a similar injury known as aPhyseal Fracture or “pseudodislocation” may also occur as the medial Physis of the Clavicle does not fuse until the age of ~23-25 (SOURCE-2+7).
The Sternoclavicular Joint is one of the most used joints in the body, leaving it subject to degenerative conditions such as Osteoarthritis (SOURCE-8). Predisposing factors are consistent with other sites of Osteoarthritis including prior injury and increased mechanical stress (SOURCE-8). An additional site specific factor is the presence of the Intraarticular Fibrocartilaginous Disc which degenerates with age and often left incomplete by the later stages of life (SOURCE-7). The onset is also consistent, where the breakdown of Cartilage leads to decreased vascular resistance, consequent neovascularisation and the ensuing accumulation of microanatomical changes in the disc and articular cartilage (SOURCE-8). In load-bearing joints such as The Knee or The Hip , compressive loads form the basis for resistance against vascular invasion as they promote dense compact cartilage (SOURCE-7). Experiencing significantly less load, the Sternoclavicular Joint may be left more susceptible, which may be apparent at early stages of disease (SOURCE-8). Disc degeneration, therefore, may serve as an early marker for Osteoarthritis in the Sternoclavicular Joint (SOURCE-8). While in the majority of instances this condition is asymptomatic, patients often complain of Pain or tenderness with arm movement (SOURCE-8). Pain may be attributed to several causes including degenerative changes or the thickening of the synovial membrane which leads to increased fluid production and joint pressure (SOURCE-8).
Traumatic Sternoclavicular Joint injuries are rare, accounting for less than 3% of all injuries to The Shoulder Girdle (SOURCE-2). These injuries occur most often in young adults with a slight male bias (SOURCE-2). Conversely, with age degenerative conditions of the Sternoclavicular Joint have a much higher prevalence. One study reporting a presence of over 89% in people over 50% (SOURCE-5). Prevalence may be heavily contingent on the presence of symptoms as another study found signs of OA degeneration in >90% of those over 60, while symptomatic OA had a reported prevalence of 53% in those of the same age braket (SOURCE-8).
A shorter Clavicle creates a less efficient lever which results in significantly more Torque at the Sternoclavicular Joint which increases stress on the joint and associated soft-tissues (SOURCE-7).
The Sternoclavicular Joint is either related or subject to numerous pathologies which may be interrelated:
Clavicle Fracture - fractures to the medial-third often occur concomitantly with Sternoclavicular Joint Dislocation (SOURCE-2). As the joint represents the primary skeletal connection with the axial skeleton, clavicular fractures greatly impede function of the entire limb (SOURCE-5)
Osteoarthritis - relatively common in the Sternoclavicular Joint, with one study reporting a prevalence of over 89% in people over 50% (SOURCE-5). Prevalence may be heavily contingent on the presence of symptoms as another study found signs of OA degeneration in >90% of those over 60, while symptomatic OA had a reported prevalence of 53% in those of the same age braket (SOURCE-8). Pain is most common for those who do experience symptoms, particularly with arm elevation (SOURCE-5+8)
Rheumatoid Arthritis - involvement of the Sternoclavicular Joint is common in RA, particularly for females (SOURCE-5)
Brachial Plexus , Vascular Injury, Oesophageal Ruptures and Tracheal Compression - a main complication following Posterior Dislocations with severe consequences (SOURCE-7)
As the only true bony articulation between the upper limb and the axial skeleton, there is a bidirectional relationship between Range of Motion of the Sternoclavicular Joint and the other joints of The Shoulder Girdle (SOURCE-9). This forms the avenue by which dysfunction in the Sternoclavicular Joint may contribute to shoulder pathologies or vise versa:
Scapular Dyskinesis - restricted or dysfunctional motion of the Clavicle directly impacts motion of the Scapula
Subacromial Impingement - abnormal Scapula motion has the capacity to impair the ability of the Acromion to sufficiently clear the Head of Humerus during overhead movements, leading to impingement
Adhesive Capsulitis - reduced motion of the Glenohumeral Joint drives excessive motion at the Scapula and Clavicle as a compensatory mechanism which may lead to increased stress and hypermobility of the Sternoclavicular Joint. Conversely, Pain or restriction at the Sternoclavicular Joint may hypothetically lead to general apprehension of shoulder movement and consequently Adhesive Capsulitis
Glenohumeral Instability - causes increased muscular effort as a compensatory mechanism to regain stability of The Shoulder Girdle . This hypothetically leads to greater stresses at the Sternoclavicular Joint and associated soft-tissues which may eventuate pathology
Audible/ palpable “Click” sensation may be associated with shoulder movement (SOURCE-2)
Visible signs of Inflammation including bruising or oedema (SOURCE-2)
Pain local to the joint
Bony Prominence or Depression
Both Shoulder - Active Range of Motion and Shoulder - Passive Range of Motion may be restricted and accompanied by an audible click, particularly GH Joint - Abduction (SOURCE-2+7). Joint Play of the Sternoclavicular Joint is used as part of the Shoulder - Passive Range of Motion assessment. This is performed by grasping the Clavicle as close to the joint line as possible and moving it proximally to distally or anteriorly to posteriorly. The other hand is used to palpate the movement at the joint. The amount and quality of movement is compared to the asymptomatic side.
Radiography (X-Rays)- while Dislocations of the Sternoclavicular Joint are difficult to visualise on X-Rays they are considered mandatory for suspected Posterior Dislocations as they rule out potential Pneumothorax, Pneumomedastinum or Haemopneumothorax (SOURCE-7). They are also a useful tool for the evaluation of osseous degenerative conditions such as Osteoarthritis where they may reveal Subchondral Cysts, Osteophytes, Subchondral Sclerosis or narrowing of the joint space (SOURCE-5). The following views may be most relevant:
Serendipity View
40º Cephalic Tilt
Heinig View
Comouted Tomography (CT-Scan)- provides superior imaging of osseous anatomy and pathology Sternoclavicular Joint, making it the modality of choice (SOURCE-5+7). Allows for 3D reconstruction of the joint to determine exact positioning (SOURCE-7). A CT-Angiography may be required for suspected intimal Tear of the Subclavian Artery (SOURCE-7)
Magenetic Resonance Imaging (MRI)- while it provides poorer resolution images when compared to CT-Scans, may be used to evaluate ligamentious injury or the state of posterior soft-tissues (SOURCE-7). These include the atriculating surfaces, disc and other ligaments (SOURCE-5).
While the majority of Sternoclavicular dislocations may be treated conservatively, indications for surgery include acute traumatic posterior dislocations or chronic injury where instability and functional impairment persists despite conservative intervention (SOURCE-2). With atraumatic instability, conservative treatment is usually commenced with immobility through the use of a sling and closed reduction techniques/ mobilisations are not recommended (SOURCE-2). Conversely with traumatic onset both mobilisations and closed reduction techniques may be indicated for adults, however there is a paucity in supporting literature for the young (SOURCE-2).
The following lists Stretching techniques may be relevant to the Shoulder that aim to either restore length of associated soft-tissues or correct overall biomechanics, with lists of targeted stretches for each Muscle on its respective page (seeKey Structuresabove):Simple:
Forward Elevation Stretch - rudimentary passive stretch with moderate GH Joint - Flexion range
Shoulder External Rotation Stretch - rudimentary active stretch with large GH Joint - External Rotation range and several variations
Seated Thoracic Rotation with Breathing - large lateral flexion and rotation range coupled with breathing
Intermediate:
Door Frame Neck Stretch - self-guided neck stretch with several variations
Door Frame Shoulder Stretch - self-guided anterior shoulder stretch with large Horizontal GH Joint - Abduction range
Dowel External Rotation Stretch - self-guided GH Joint - External Rotation stretch with overpressure
Bent Over Lat Stretch - accessible active stretch with large GH Joint - Flexion or Horizontal GH Joint - Adduction range
Split Stance Biceps Stretch - self-guided anterior shoulder stretch with large GH Joint - Extension range
Banded Capsule Rolls - split stance biceps variation that emphasises shoulder rotation
Advanced:
Shoulder Dislocates - mobility exercise that emphasises the greatest circumduction range possible
Swimmers Oblique Extensions - exercise that may be used to lengthen entire Lateral Line through large body-wide lateral-flexion range
Bretzel 1.0 - wholebody technical stretch that incorporates anterior shoulder
Bretzel 2.0 - variation with greater hip extension range
Wheel Pose - full bridge variation that lengthens entire anterior chain
Jefferson Curl - maximal stretch for posterior chain with emphasis on intersegmental movment of the Vertebral Column and capacity to add load
Dead Hangs - whole body traction for Pull and Push muscles with large overhead range
Strength training forms an integral role of shoulder (p)rehabilitation and enables individuals to improve function/ capacity. Resistance movements for the shoulder not only improve strength but neuromuscular control which coordinates quality motion at the numerous shoulder articulations. While many listed exercises may be progressed through load or time under tension, the following details shoulder movements in rough order of most rudimentary to sophisticated.
Initial Phase - typically used in the early phases of (p)rehabilitation to mitigate Muscle atrophy, provoke activity and cue appropriate joint motion:
Shoulder Sling - Scapula setting exercise
Rotator Cuff Pendulums - oscillatory motion that afford a distracting glide to the Humeral Head
Prone Cobra - isometric exercise that emphasises Middle and Lower Trapezius
Rotator Cuff Banded Rotations - light low range isotonic rotation exercises
Prone Shoulder External Rotations - adds gravity or light load to Apprehension Test position
Isometric Chest Squeezes - isometric exercise that isolates Chest
Band Pull-Apart - basic isotonic exercise for Scapular Retractors
Banded Horizontal Adduction - low load isotonic horizontal adduction exercise
Side-Lying Shoulder External Rotations - maximises effect of gravity against External Rotation with upper arm fixed against torso
Standing Shoulder External Rotations - incorporates upright torso posture
Banded Unilateral Lat Activations - activate lat, posteroinferior drawer on Humerus
Bird-Dog - bodyweight isotonic exercise that emphasises Posterior Sling / Core
Circumduction Row - isotonic exercise with variable load used to emphasise mid-to-lower Trapezius
Scapular Punches - isotonic exercise that emphasises Scapulothoracic Joint - Protraction
Bottoms-Up Kettlebell Walk - isometric push/ stability exercise with or without perturbation
Chest Press Machine - rudimentary horizontal push machine
Pallof Press - low load horizontal push exercise that emphasises anti-rotation of Core
Mid-Phase - simple strength exercises that may be relevant once Pain -free motion is achieved:
Inverted Rows - rudimentary isotonic horizontal pull exercise that utilises bodyweight
Push-Up - bodyweight isotonic horizontal push exercise
Push-Up Plus - push-up variation with additional Scapulothoracic Joint - Protraction
Seated Row - rudimentary weighted isotonic horizontal pull movement
Lat Pulldown - rudimentary weighted isotonic vertical pull movement with a high range of motion
Overhead Press - isotonic vertical push exercise with large overhead range
One Arm Row - unilateral DB version of Seated Row
DB Shoulder Press - unilaterally loaded overhead press variation
Face Pulls - bilateral isotonic horizontal pull exercise that emphasises GH Joint - External Rotation
Bench Press - isotonic horizontal push exercise with capacity for high loads
Incline DB Bench Press - unilaterally loaded Bench variation on variable incline
Straight Arm Lat Pulldown - isotonic motion that emphasises Lats and straight arm strength
Front Raises - isotonic GH Joint - Flexion exercise with many variations
Side Raises - isotonic GH Joint - Abduction exercise with many variations
Bent Over Row - weighted isotonic horizontal pull exercise that emphasises entire posterior chain
Dips - bodyweight isotonic push exercise with large GH Joint - Extension range
DB Pullover - moderate isotonic movement with large overhead and Thoracic - Extension range
Chest Fly - large horizontal abduction range to emphasise lengthening of the Chest
Upright Row - weighted isotonic vertical pull exercise that emphasises Upper Trapezius and Deltoid
Shrug - weighted isotonic exercise that emphasises Scapulothoracic Joint - Elevation
Farmers Carry - upperbody/ Core isometric exercise with perturbation of walking
Late Phase - exercises at this stage should more closely reflect the activities/ demands of the patient. Relevant functional patterns should be promoted and exercises should be progressed in complexity and intensity:
Push Press - wholebody, explosive variation of the Overhead Press
DB Hang Clean - unilateral clean progression, often performed explosively
Bottoms-Up Kettlebell Walk - typically isometric exercise for entire arm musculature with perturbation from walking
Prone Lat Pulldown - Lat Pulldown variation that emphasises Thoracic - Extension
Lu Raises - large GH Joint - Abduction range with no Humerus rotation to promote Scapulothoracic Joint - Upward Rotation
Half DB Bench Press - unilateral isotonic horizontal pressing motion that emphasises the Anterior Sling
Pull-Up - bodyweight or greater load through large overhead motion
Kneeling Landmine Press - wholebody, explosive vertical pressing exercise with large
Split Stance Landmine Press - crossbody, standing variation of the Kneeling Landmine Press
DB Snatch - unilateral isotonic, explosive shoulder exercise with large overhead range
Medball Pullover Throw - plyometric Pullover variation
Medicine Ball Chest Press - plyometric horizontal pressing motion, often sports relevant
Suitcase Carry - unilateral farmers carry which emphasises crossbody functional patterns
Rope Climb - pull-up variation with entire load bestowed on alternating arm
DB Snatch to Step-Up - wholebody DB Snatch variation that emphasises diagonal functional patterns
Bird-Dog Row - One Arm Row variation that emphasises Posterior Sling
Myofascial Release of the following structures through Massage or self-guided means may be of benefit to those with Sternoclavicular Joint pathology, with specific techniques discussed on their respective pages:
While there is a capacity for many Mobilisations of The Shoulder Girdle or Cervical Spine to treat the Sternoclavicular Joint, the following list those that can be applied directly. Intuitively, the technique most likely relevant will be against the malalingment of the medial Clavicle :
Closed Reduction Techniques - may be attempted within the acute phase of injury (7-10 days), although recurrence rates are high (SOURCE-7):
Anterior Dislocation - patient lies supine with posterior Scapula raised and stabilised. Practitioner applies a Sternoclavicular Posterior Glide . Anaesthesia may be required (SOURCE-2)
Posterior Dislocation - patient is in 90º GH Joint - Abduction while the practitioner applies a Sternoclavicular Anterior Glide . As this is sustained the patients arm is moved into GH Joint - Extension (SOURCE-2)
Where conservative treatment has failed or in populations such as the young where techniques such as closed reduction may not be indicated, surgery may be recommended (SOURCE-2). Specific techniques available to the Sternoclavicular Joint include open reduction and stabilisation, ligament reconstruction or in chronic instances, joint reconstruction (SOURCE-2). Generally speaking atraumatic injuries and anterior Dislocations are conservatively, while management of acute Posterior Dislocations is determined by the presence of mediastinal injury (SOURCE-5). Concomitant mediastinal injury is an indication for open reduction and internal fixation while isolated Posterior Dislocations may require closed reduction (SOURCE-5).
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