Sternoclavicular Joint Injury
Upper LimbOverview
Sternoclavicular (SC) joint injury encompasses acute traumatic injuries and chronic degenerative conditions affecting the articulation between the clavicle and sternum, representing 3-5% of all shoulder girdle injuries. The SC joint is the primary articulation connecting the upper limb to the axial skeleton and is critical for shoulder and arm function. Injuries range from ligamentous sprains and intra-articular disc displacement to fracture-dislocations, with anterior dislocations being more common than posterior dislocations.
Pathophysiology
The SC joint is a saddle joint with inherent laxity, stabilised primarily by ligaments (anterior and posterior capsular, interclavicular, and costoclavicular ligaments) rather than bony anatomy. Traumatic injury typically occurs from high-velocity mechanisms or direct anteroposterior force applied to the shoulder, disrupting ligamentous support and causing hypermobility, inflammation, and joint irritation. Chronic SC joint dysfunction may develop from repetitive microtrauma, postural dysfunction, or osteoarthritis affecting the articulating cartilage, leading to intra-articular inflammation and referred pain patterns. Anterior dislocations cause prominence visible at the sternal notch, while posterior dislocations risk compression of mediastinal structures (trachea, oesophagus, great vessels) due to anatomical proximity.
Patient Education
SC joint injuries require careful monitoring for swelling and deformity changes; while most anterior dislocations are managed conservatively with progressive rehabilitation, persistent instability or posterior displacement requires urgent medical imaging and possible specialist referral.
Typical Presentation
Site
Anterior chest at the medial clavicle and sternal notch; pain may radiate medially to the sternum, superiorly to the neck, or laterally across the anterior shoulder
Quality
Sharp, stabbing pain with acute injury; aching, grinding, or clicking sensations with chronic dysfunction; clicking or clunking may accompany arm movement
Intensity
Acute injuries: 6-8/10 immediately post-injury, reducing over days; chronic: 3-5/10 with activity, may spike with specific movements
Aggravating
Cross-body adduction (opposite arm across chest), horizontal adduction, arm elevation overhead, loaded pushing activities, certain sleeping positions (pressure on medial clavicle), prolonged desk work, deep inspiration if joint is inflamed
Relieving
Rest and immobilisation in acute phase, arm sling support, heat application, anti-inflammatory measures, keeping arm at side, gentle pendulum motions once acute pain subsides
Associated
Visible deformity or prominence at sternal notch (anterior dislocation), swelling and bruising over medial clavicle, restricted shoulder range of motion (especially cross-body adduction and elevation), referred pain to anterior neck or upper thorax, clicking or clunking with arm movement, postural changes with forward shoulder posture, chest wall discomfort, rarely dysphagia or dyspnoea if posterior dislocation compresses mediastinal structures
Orthopaedic Tests
Test descriptions are written with AI assistance from standard clinical texts. Where a test lists Sources, its description has been checked against them; those sources are independent and do not endorse OsteoKit. Accuracy figures and grades (A–D) appear only when checked against the published study; tests without one are marked “No accuracy study”.
Further reading: full test procedures are described in standard clinical examination texts, e.g. Magee & Manske, Orthopedic Physical Assessment (7th ed.), and Cook & Hegedus, Orthopedic Physical Examination Tests: An Evidence-Based Approach (2nd ed.).
Sternoclavicular Joint Palpation
Procedure
Patient seated or supine. Inspect both sternoclavicular joints for swelling or asymmetry, then palpate the medial end of each clavicle.
Positive Finding
Tenderness, swelling or a step at the joint compared with the other side.
Interpretation
Supports a sternoclavicular joint injury. A medial clavicle that feels displaced backwards (a hollow rather than a bump), or any difficulty breathing or swallowing, hoarse voice or arm swelling, suggests a posterior dislocation, which can compress the great vessels or airway and needs emergency referral. Imaging (CT) confirms the direction of displacement. This injury is diagnosed by imaging; these provocation/palpation signs have no validated diagnostic accuracy.
Sternoclavicular Compression Test (Crossover Adduction)
Procedure
Once a posterior dislocation has been excluded: with the patient seated, bring the arm across the body towards the opposite shoulder, or press gently along the clavicle towards the sternum.
Positive Finding
Reproduction of the familiar pain at the sternoclavicular joint.
Interpretation
Loads the joint and supports it as the pain source. Cross-body adduction also loads the acromioclavicular joint, so note exactly where the pain is felt.
Sternoclavicular Shear Test (Horizontal Abduction)
Procedure
Once a posterior dislocation has been excluded: stabilise the sternum with one hand and gently glide the medial clavicle forwards and backwards with the other, comparing sides.
Positive Finding
Reproduction of the familiar pain, or more movement than on the other side.
Interpretation
Suggests sternoclavicular sprain or laxity. Not a validated test; judging joint movement by hand is unreliable, so use it to locate pain rather than to grade instability.
Serratus Anterior Weakness Test (Scapular Dyskinesis Assessment)
Procedure
Observe from behind while the patient does a slow wall push-up and raises and lowers both arms.
Positive Finding
Winging of the medial border of the scapula, or poor control of scapular movement.
Interpretation
Describes scapular control to guide rehabilitation after the injury. Marked winging at rest or with a wall push-up suggests long thoracic nerve involvement and needs further assessment.
Clavicle Excursion Test
Procedure
Observe and palpate the medial clavicle while the patient shrugs, protracts and retracts the shoulders, comparing sides.
Positive Finding
Pain, clicking or visibly abnormal movement at the sternoclavicular joint during shoulder movement.
Interpretation
Not a recognised named test. Useful to find which shoulder-girdle movements provoke pain, for treatment and monitoring.
Cross-Body Adduction Test (Horizontal Adduction Maneuver)
Procedure
Patient seated. Raise the arm to 90° of flexion and bring it across the body towards the opposite shoulder, adding gentle overpressure.
Positive Finding
Pain at the sternoclavicular joint, or at the acromioclavicular joint.
Interpretation
Loads both ends of the clavicle. Ask the patient to point to the pain: pain at the top of the shoulder suggests the acromioclavicular joint; pain at the base of the neck the sternoclavicular joint.
⚠ Red Flags
- •Posterior SC dislocation with signs of vascular compromise (pale, cold arm; absent radial pulse)
- •Posterior dislocation with respiratory distress, dysphagia, or stridor (mediastinal compression)
- •Acute severe trauma with signs of underlying rib fracture, pneumothorax, or chest wall trauma
- •Severe uncontrolled swelling suggesting haemarthrosis requiring aspiration
- •Signs of concurrent brachial plexus injury (neurological symptoms in arm distribution)
- •Progressive neurological deficit or vascular compromise
- •High-velocity trauma with suspicion of fracture-dislocation on presentation
⚡ Yellow Flags
- •Frequent recurrent dislocations suggesting chronic instability and possible secondary psychological distress
- •Excessive reassurance-seeking or fear-avoidance behaviour regarding mediastinal complications
- •Chronic anxiety about posterior dislocation risk limiting normal shoulder use
- •Occupational stress from inability to perform overhead or pushing work activities
- •Prolonged disability disproportionate to clinical findings suggesting illness perception issues
- •History of hypermobility-related conditions with potential generalised ligamentous laxity
- •Avoidance of rehabilitation due to fear of re-injury or dislocation
Osteopathic Techniques
Sprains and most anterior dislocations are managed without surgery: a sling for comfort, physiotherapy, pain relief and a graded return to activity. No trials of manual techniques were found.
- Reference bookKiel et al. · StatPearls 2023
Safety: A posterior SC dislocation is different: reduced pulses, trouble swallowing or shortness of breath point to vascular, mediastinal or lung injury and need emergency surgical care.
- Reference bookKiel et al. · StatPearls 2023
Region
AC joint, clavicle and SC joint
Technique
Rationale
Gentle, patient-powered correction of SC or clavicle restriction after a sprain. No trials.
How it's done, cautions & evidence
How it's done
Patient seated or supine. Monitor the AC or SC joint with one hand and use the arm as a lever to take the joint to its barrier (for example, external rotation for an internally rotated AC joint, or more abduction for an adducted clavicle). The patient pushes gently against isometric resistance for 3–5 seconds, relaxes, and the joint is taken to the new barrier. Repeat 3–5 times, then re-check.
Cautions
Very safe, but not used with a fracture, a ruptured ligament, tendon or muscle, a joint infection, or when no dysfunction is found.
Evidence in Sternoclavicular Joint Injury
Searched 24 Oct 2026: no trials of SC joint or clavicle MET in SC joint injuries.
Sources
- Reference bookDowning & Bordoni · StatPearls 2023
Region
Periscapular and upper thoracic muscles
Technique
Rationale
Eases tension around the upper chest and back. No trials in SC injuries.
How it's done & evidence
How it's done
Hands-on soft-tissue work (kneading, stretching and sustained pressure) to the thoracic paraspinals, rhomboids, middle trapezius and the muscles along the rib angles, usually prone or side-lying.
Evidence in Sternoclavicular Joint Injury
Searched 24 Oct 2026: no trials of upper thoracic soft tissue technique in SC joint injuries.
Sources
- Journal articleFurlan et al. · Cochrane 2015
Rehabilitation Exercises
Pendulum Swings (Codman's Pendulum Mobilisation)
Cross-Body Shoulder Stretch (Gentle, Pain-Free Range)
Pectoralis Major Doorway Stretch
Shoulder Shrugs and Rolls
Scapular Retraction (Prone Y-Raises)
Serratus Anterior Activation (Wall Push-Ups with Scapular Protraction)
Prone Shoulder External Rotation (Sleeper Stretch Strengthening)
Postural Correction: Chin Tucks and Upper Thoracic Extension
Thoracic Extension Mobilisation (Foam Roller or Towel Roll)
Resistance Band Rows (Prone, Supine, and Standing Variations)
Proprioceptive Shoulder Stability (Quadruped Shoulder Taps and Holds)
Progressive Loaded Shoulder Flexion and Abduction (Dumbbell or Theraband)
Referral Criteria
- •Acute posterior SC dislocation or suspicion thereof (medical emergency for imaging and reduction)
- •Anterior dislocation with signs of vascular compromise or mediastinal compression
- •Fracture-dislocation confirmed on imaging requiring specialist orthopaedic assessment
- •Recurrent dislocation (more than 2 episodes) requiring surgical evaluation for reconstruction
- •Persistent severe pain or dysfunction unresponsive to conservative care after 6-8 weeks
- •Signs of intra-articular loose body or mechanical block preventing movement (MRI or ultrasound indicated)
- •Development of complex regional pain syndrome characteristics (excessive swelling, colour changes, temperature changes)
- •Concurrent injuries requiring orthopaedic input (rib fractures, clavicular shaft fractures, brachial plexus injury)
- •Haemarthrosis requiring aspiration for symptom relief and diagnosis
- •Chronic SC joint osteoarthritis with progressive instability or pain affecting occupational function
- •Underlying hypermobility syndrome (EDS, Marfan syndrome) requiring specialist medical management
- •Symptoms persisting beyond expected healing timelines with imaging showing retained intra-articular displacement