Sternoclavicular Separation

ExitCare ImageA sternoclavicular separation is an uncommon injury. It occurs when the ligaments between the breastbone (sternum) and collarbone (clavicle) are stretched or torn (sprained). A sprain of these ligaments can vary in severity. Sprains are classified into 3 categories. Grade 1 sprains cause pain, but the tendon is not lengthened. Grade 2 sprains include a lengthened ligament, due to the ligament being stretched or partially ruptured. With grade 2 sprains, there is still function, although function may be decreased. Grade 3 sprains are marked by a complete tear of the ligament. The joint has a loss of function.

SYMPTOMS

  • Severe pain, tenderness, swelling, bruising, and sometimes a bony bump at the sternoclavicular joint.

  • Pain at the sternoclavicular joint when trying to bring the affected arm across and in front of the body.

  • Respiratory symptoms. (This is rare, but if any occur, it is an emergency situation.)

  • Hoarse voice.

  • Difficulty swallowing.

  • Neck fullness.

  • Choking sensation.

CAUSES

  • This condition is caused by injury (trauma) to the ligament that connects the sternoclavicular joint. If the injury places a greater force on the ligament than it can withstand, a sprain occurs.

  • Common injuries causing a sternoclavicular separation are:

  • Collarbone injury.

  • Violent force from the side.

  • Compression of the shoulder toward the sternum.

  • Falling on an outstretched hand (less common).

RISK INCREASES WITH:

  • Contact sports (football, soccer, boxing) and weightlifting.

  • Previous collarbone injury or sternal injury.

  • Poor strength and flexibility.

  • Inadequate or poorly fitted protective equipment.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain proper conditioning:

  • Shoulder and arm flexibility.

  • Muscle strength and endurance.

  • Wear properly fitted and padded protective equipment (chest and shoulder pads).

  • Learn and use proper technique (including falling and landing). Have a coach correct improper technique.

  • Taping, protective strapping, or an adhesive bandage may be advised before practice or competition.

PROGNOSIS

If treated properly, sternoclavicular separations can typically be cured. Healing time varies, depending on the severity of the injury and the type of sport played. Occasionally, surgery is needed to repair the torn ligaments.

RELATED COMPLICATIONS

  • Weakness and fatigue of the arm and shoulder (uncommon).

  • Continued pain and inflammation of the sternoclavicular joint.

  • Longer healing time and being vulnerable to recurrent injury, if usual activities are resumed too soon.

  • Prolonged pain or disability (occasionally).

  • Unstable or arthritic shoulder, following repeated injury.

  • Death from posterior displacement of collarbone into airway, arteries, veins, or nerves of the neck.

TREATMENT

Treatment first involves ice and medicine to reduce pain and inflammation. The sternoclavicular joint is typically immobilized with an arm sling for a period of time. This allows for healing. Strengthening and stretching exercises may be needed to prevent shoulder stiffness after immobilization. These exercises may be performed at home or with a therapist. Return to sport depends upon:

  • The severity of injury.

  • The type of sport played.

Surgery may be needed, especially if the sprain is posteriorly displaced (collarbone goes backward into the neck). This may cause compression of the vital structures in the neck, including the:

  • Airway.

  • Voice box.

  • Blood vessels to the arms or head.

Posteriorly displaced sprains are a medical emergency and must be treated immediately. Rarely, surgery is needed for those with chronic pain who have not recovered after 4 to 6 months of non-surgical treatment.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be prescribed. Use only as directed and only as much as you need.

  • Ointments applied to the skin may be helpful.

  • Injections of corticosteroids may be given to reduce inflammation. However, this medicine is not usually used for acute injuries.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or massage the area with a piece of ice (ice massage).

  • Heat treatment may be used before performing the stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or soak your injury in warm water.

SEEK MEDICAL CARE IF:

  • Pain, swelling, or bruising gets worse, despite treatment.

  • You experience pain, numbness, swelling, or coldness in the arm.

  • Blue, gray, or dark color appears in the fingernails.

  • You develop a hoarse voice or difficulty swallowing.

  • The collarbone moves back out of normal position (if it was repositioned).

  • Any of the following occur after surgery:

  • Increased pain, swelling, redness, drainage of fluids, or bleeding from the surgical area.

  • Signs of infection (headache, muscle aches, dizziness, or general ill feeling with fever).

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)