Sternoclavicular joint surgery may be employed to repair and restore function toa damaged or unstable sternoclavicular joint.
The sternoclavicular (SC) joint is the joint between the breastbone (sternum) and the collar bone (clavicle). Injuries to this joint are called sternoclavicular joint injuries and can include stretching or tearing of the ligaments. It is usually caused due to severe trauma or a direct blow to the side of your body such as in motor vehicle accidents or contact sports. The joint is also an uncommon place to develop arthritis as we age, especially in women.
Anatomy
The SC joint is one of the 4 joints that complete the shoulder and is the only joint that links the arm to the body. Like any other joints, the SC joint is covered by articular cartilage that helps the bones slide effortlessly along each other during arm and shoulder movement. Tough connective tissue known as ligaments surrounds the SC joint providing stability and strength.
Symptoms of Sternoclavicular Joint Injury
Typically, symptoms of sternoclavicular joint disorders include:
- Pain localised over the SC joint region
- Tenderness, bruising or swelling over the SC joint
- Limited range of motion in the arm
- Grinding or crunching sound on arm movement
- Difficulty sleeping on the affected side
Indications for Sternoclavicular Joint Surgery
Sternoclavicular joint surgery may be indicated when conservative treatment fails to alleviate symptoms of sternoclavicular joint injury or if you have an irreducible or recurrent posterior instability or chronic and symptomatic anterior instability of the joint . Surgery may also occasionally be undertaken for symptomatic arthritis of the SC joint if non-operative measures fail.
Procedure for Sternoclavicular Joint Surgery
The surgery is performed under general anaesthesia. An oblique incision is made across the medial end of the clavicle. A vertical incision is made in the capsule of the sternoclavicular joint and the status of the intra-articular disc is evaluated. If the joint is arthritic then a small portion of the inner end of the clavicle is excised, preserving the surrounding ligaments.
If the joint is unstable then these ligaments will usually need to be reconstructed. This can be done either using the sternocleidomastoid muscle or by using a free tendon graft (preferred). The tendon of the sternal head of the sternocleidomastoid muscle is exposed and its quality and thickness are assessed before transfer. The tendon is separated from the muscle. A drill hole is made in the medial end of the clavicle. The hole is placed lateral to the attachment of the capsule. The tendon is passed through the capsule and then pulled through the drill-hole in the clavicle. The remaining tendon is passed through the capsule again before being returned to its site of insertion. The tendon is then pulled to reduce the joint and secured with sutures. If a free tendon graft is used, then this will be passed from the medial end of the clavicle to the sternum (breastbone) and attached in a figure-of-eight fashion. The overlying tissues are then closed in layers and the skin is closed with absorbable sutures.
Postoperative Care
Post procedure, your doctor will provide you with instructions that need to be followed diligently for a successful outcome and include:
- Wearing a sling for a period of up to 6 weeks
- Activity restrictions on heavy lifting for several months
- Maintaining range of motion of the wrist, elbow, and hand for light activity
- Physical therapy to strengthen muscles and restore movement