Sternoclavicular Joint Sprain

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Sternoclavicular Joint Sprain

Sternoclavicular joint injuries involve the sternoclavicular joint and its associated ligaments and can be of a traumatic or atraumatic etiology. Traumatic Injury to the sternoclavicular joint is reported to be caused most commonly by motor vehicle accidents or sporting trauma. The mechanism of injury is said to be that of compression force to the lateral shoulder, together with a vector that drives the medial end of the clavicle anteriorly or posteriorly, typically resulting in a sprain of the joint. When the injury is severe dislocation may occur. In cases of atraumatic injury, the usual mechanism is sustained activity with the arm in an elevated position.

With only half of the medial end of the clavicle in direct contact with the manubrium, the sternoclavicular joint is an inherently unstable joint relying on ligamentous support. The joint contains an intra-articular disc which acts as a shock absorber and allows for a greater range of mobility.

Injuries of the sternoclavicular joint are classified into three types based on their severity:

Grade I – Sprain: An incomplete tear or stretching of the sternoclavicular and costoclavicular ligaments.

Grade II – Subluxation: A complete tear of the sternoclavicular ligament but only a partial tear of the costoclavicular ligament.

Grade III – Dislocation: A complete rupture of the sternoclavicular and costoclavicular ligaments.

• Anterior chest pain primarily localized at the sternoclavicular joint
• Pain aggravation with arm movement
• Pain aggravation when lying on the side of involvement
• Pain may occur with neck flexion in the supine position
• Posterior dislocation may lead to dyspnea, stridor, dysphagia, or upper limb paresthesia

• Swelling or prominence at the medial end of the clavicle
• Tenderness on palpation over the sternoclavicular joint
• May have local ecchymosis
• Pain aggravation with shoulder abduction, flexion, or horizontal adduction
• Pain aggravation with resisted neck flexion
• Special tests of the shoulder joint may aggravate the patient’s pain (e.g., the Painful Arc and Acromioclavicular Crossover tests)

Plain radiography may be used to check for a widening of the sternoclavicular joint or clavicular dislocation. Computerized Tomography (CT) may be required in cases of posterior dislocation to better evaluate mediastinal structures.

The following are examples of “red flags” for patients presenting with trauma-induced chest pain:

• History of a significant injury
• Severe pain
• Unrelenting pain
• Nocturnal pain or pain at rest
• Fever
• Deformity
• Large joint swelling
• Significant loss of range of motion
• Significant neurological impairment (suggestive of a space-occupying lesion)
• Severe tenderness on palpation or severe pain with any examination procedure
• Dyspnea, stridor, dysphagia, or upper limb paresthesia

If any “red flags” are identified during history taking and clinical examination, referral for urgent medical evaluation and further investigation is warranted.

Upper Chest Pain Differential Diagnosis

In adults, in addition to Sternoclavicular Joint Sprain, the differential diagnosis of upper anterior chest pain should include other conditions such as:

• Tietze syndrome
• Sternalis muscle myofascial pain syndrome
• Sternocleidomastoid strain
• Cardiac disorders