Sternoclavicular Joint: Difference between revisions
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Anterior | Anterior | ||
Sternoclavicular | Sternoclavicular | ||
Ligament <br> | Ligament <br> | ||
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<br> Broad band of fibers, | |||
Broad band of fibers, | |||
covering anterior surface of | covering anterior surface of | ||
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SC Joint | SC Joint | ||
r<span style="text-align: left;">unning o</span><span style="text-align: left;">bliquely from </span | r<span style="text-align: left;">unning o</span><span style="text-align: left;">bliquely from </span> | ||
<span style="text-align: left;">Proximal Clavicle to Sternum </span> | |||
<span style="text-align: left;">in a downward and medial </span> | |||
<span style="text-align: left;">direction</span><span style="text-align: left;" /> | |||
<br> | |||
<br> | |||
<br> | |||
| align="center" | | | align="center" | | ||
Superior & Anterior Aspect | Superior & Anterior Aspect | ||
Sternal End Clavicle | Sternal End Clavicle | ||
| align="center" | | | align="center" | | ||
Anterior Superior Aspect | Anterior Superior Aspect | ||
of Manubrium | of Manubrium | ||
| align="center" | | | align="center" | | ||
<span style="line-height: 1.5em;">Reinforce </span><span style="line-height: 1.5em;">Capsule </span><span style="line-height: 1.5em;">Anteriorly</span> | <span style="line-height: 1.5em;">Reinforce </span><span style="line-height: 1.5em;">Capsule </span><span style="line-height: 1.5em;">Anteriorly</span> | ||
Limits Anterior Translation of Clavicle | |||
Checks Anterior Movement of Head of Clavicle | Checks Anterior Movement of Head of Clavicle | ||
|- | |- | ||
| | | | ||
Posterior | Posterior | ||
Sternoclavicular <br> | Sternoclavicular <br> | ||
Ligament <br> | Ligament <br> | ||
| align="center" | | | align="center" | | ||
<br> Broad band of fibers,<br> | |||
covering posterior surface of<br> | |||
SC Joint | |||
SC Joint | |||
<br> | |||
Weaker than the Anterior Sternoclavicular Ligament. | Weaker than the Anterior Sternoclavicular Ligament. | ||
<br> | |||
| align="center" | | | align="center" | | ||
Superior & Posterior Aspect | Superior & Posterior Aspect | ||
Sternal End Clavicle | Sternal End Clavicle | ||
| align="center" | | | align="center" | | ||
Posterior Superior Aspect | Posterior Superior Aspect | ||
of Manubrium | of Manubrium | ||
| align="center" | | | align="center" | | ||
<br> Reinforce Capsule Posteriorly | |||
<span style="text-align: left;">Limits Posterior Translation of Clavicle</span> | |||
<span style="text-align: left;">Checks Posterior Movement of Head of Clavicle</span> | |||
<span style="text-align: left;">Checks Posterior Movement of Head of Clavicle</span> | |||
<br> | |||
|- | |- | ||
| | | | ||
Costoclavicular | Costoclavicular | ||
Ligament <br> | Ligament <br> | ||
| align="center" | | | align="center" | | ||
Line 130: | Line 124: | ||
Sternal End of Clavicle to 1st | Sternal End of Clavicle to 1st | ||
Rib & its Costal Cartilage | Rib & its Costal Cartilage | ||
<br> | |||
Orientation allows this | Orientation allows this | ||
Line 138: | Line 132: | ||
ligament to act as the Primary | ligament to act as the Primary | ||
Restraint for the SC Joint | Restraint for the SC Joint | ||
| align="center" | | | align="center" | | ||
Base Lateral Border | Base Lateral Border | ||
Coracoid Process | Coracoid Process | ||
| align="center" | | | align="center" | | ||
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Tubercle; Blending with | Tubercle; Blending with | ||
Supraspinatus Tendon | Supraspinatus Tendon | ||
| align="center" | | | align="center" | | ||
Limits Elevation of Pectoral Girdle | Limits Elevation of Pectoral Girdle | ||
Acts as Fulcrum for Elevation-Depression Protration-Retraction | Acts as Fulcrum for Elevation-Depression Protration-Retraction | ||
<span style="text-align: left;">Checks Clavicular Elevation and Superior Glide of Clavicle</span> | <span style="text-align: left;">Checks Clavicular Elevation and Superior Glide of Clavicle</span> | ||
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Interclavicular | Interclavicular | ||
Ligament | Ligament | ||
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<span style="line-height: 19.920000076293945px; text-align: left;">Connects Sternal Ends of Each Clavicle with Capsular Ligaments and Upper Manubrium</span> | <span style="line-height: 19.920000076293945px; text-align: left;">Connects Sternal Ends of Each Clavicle with Capsular Ligaments and Upper Manubrium</span> | ||
<span style="line-height: 19.920000076293945px; text-align: left;">Produces a Bilateral Depression Force</span> | <span style="line-height: 19.920000076293945px; text-align: left;">Produces a Bilateral Depression Force</span> | ||
| align="center" | Sternal End of One Clavicle | | align="center" | Sternal End of One Clavicle | ||
| align="center" | Sternal End of Other Clavicle | | align="center" | Sternal End of Other Clavicle | ||
| align="center" | | | align="center" | | ||
Strengthens Capsule Superiorly | Strengthens Capsule Superiorly | ||
<span style="text-align: left;">Resists Excessive Depression or Downward Glide of Clavicle</span> | <span style="text-align: left;">Resists Excessive Depression or Downward Glide of Clavicle</span> | ||
|} | |} | ||
<br> | <br> | ||
[[Image:Ligaments-of-the-Sternoclavicular-Joint-1024x312.png|center|750px]]<br> | [[Image:Ligaments-of-the-Sternoclavicular-Joint-1024x312.png|center|750px]]<br> |
Revision as of 17:40, 9 June 2015
Original Editor - Tyler Shultz
Top Contributors - Naomi O'Reilly, Tyler Shultz, Redisha Jakibanjar, Kim Jackson, Admin, Mariam Hashem, Andeela Hafeez, Rachael Lowe, Vanessa Rhule, Alexandra Kopelovich, 127.0.0.1, Tarina van der Stockt and WikiSysop
Description[edit | edit source]
The sternoclavicular joint (SC joint) is formed from the articulation of the medial aspect of the clavicle and the manubrium of the sternum. It is one of four joints that compose the shoulder complex. The SC joint is generally classified as a plane style synovial joint, and has a fibrocartilage joint disk.[1] The ligamentous reinforcements of this joint are very strong, often resulting a fracture of the clavicle before a dislocation of the SC joint.[2]
Anatomy
[edit | edit source]
Joint Capsule:[edit | edit source]
The SC Joint capsule is fairly strong but is dependent on the ligaments noted above for the majority of its support.
Ligaments [3][4]
[edit | edit source]
LIGAMENT |
DESCRIPTION | PROXIMAL ATTACHMENT | DISTAL ATTACHMENT | ROLE |
---|---|---|---|---|
Anterior Sternoclavicular Ligament |
covering anterior surface of SC Joint running obliquely from Proximal Clavicle to Sternum in a downward and medial direction<span style="text-align: left;" />
|
Superior & Anterior Aspect Sternal End Clavicle |
Anterior Superior Aspect of Manubrium |
Reinforce Capsule Anteriorly Limits Anterior Translation of Clavicle Checks Anterior Movement of Head of Clavicle |
Posterior Sternoclavicular Ligament |
covering posterior surface of SC Joint
Weaker than the Anterior Sternoclavicular Ligament.
|
Superior & Posterior Aspect Sternal End Clavicle |
Posterior Superior Aspect of Manubrium |
Limits Posterior Translation of Clavicle Checks Posterior Movement of Head of Clavicle
|
Costoclavicular Ligament |
Anchors Inferior Surface of Sternal End of Clavicle to 1st Rib & its Costal Cartilage
Orientation allows this ligament to act as the Primary Restraint for the SC Joint |
Base Lateral Border Coracoid Process |
Anterior Aspect Greater Tubercle; Blending with Supraspinatus Tendon |
Limits Elevation of Pectoral Girdle Acts as Fulcrum for Elevation-Depression Protration-Retraction Checks Clavicular Elevation and Superior Glide of Clavicle |
Interclavicular Ligament |
Connects Sternal Ends of Each Clavicle with Capsular Ligaments and Upper Manubrium Produces a Bilateral Depression Force |
Sternal End of One Clavicle | Sternal End of Other Clavicle |
Strengthens Capsule Superiorly Resists Excessive Depression or Downward Glide of Clavicle |
Joint Disk:[5][6] [edit | edit source]
The SC joint is surprisingly incongruent, and because of this incongruency a joint disk is present to enhance joint curvature and contact of the joint surfaces. Similar to the meniscus of the knee, the SC joint disk increases joint congruence and acts to absorb foces that may be transmitted along the clavicle. The disk is attached to the upper and perior margin of the the clavicle, and to the cartilage of the first rib, and functions to help prevent medial displacement of the clavicle. This orientation divides the joint into seperate cavities. Greater movement occurs between the disk and the clavicle than between the disk and the manubrium. ===
Muscles[edit | edit source]
There are no muscles that act directly on the SC joint. However, the SC joint motions closely mimic the reciprical motions of the scapula. In addition, the following muscles have an attachment of the clavicle and therefore may produce movement of the clavicle:
- Deltoid
- Pectoralis Major (Clavicular Head)
- Trapezius
- Sternocleidomastoid
Function[edit | edit source]
Motions Available[edit | edit source]
- Protraction and retraction:[7] During protraction, the concave surface of the medial clavicle moves on the convex sternum, producing an anterior glide of the clavicle, and an anterior rotation of the lateral clavicle. With retraction, the medial clavicle articulates with a flat surface and tilts or swings, causing an anterolateral gapping, and a posterior rotation at the lateral end. These movements are usually associated with abduction (protraction) and adduction (retraction) of the scapula, since the scapula is attached to the distal end of the clavicle.[8]
- Elvation and depression:[9] During elevation, the clavicle rotates upward on the manubrium, and produces and inferior glide to maintain joint contact. The reverse actions happen when the clavicle is depressed. The motions are usually associated with elevation and depression of the scapula.
Closed Packed Position[edit | edit source]
Maximum shoulder elvation
Open Packed Position[edit | edit source]
Open-packed position of the SC joint is when the arm is resting by the side.
Pathology / Injury[edit | edit source]
The Sternoclavicular Joint is vulnerable to the same disease processes as other synovial joints, the most common of which are instability from injury, osteoarthritis, infection and rheumatoid disease. Patients may also present with other conditions, which are unique to the joint, or are manifestations of a systemic disease process.The most common clinical presentation is pain and swelling in the area of the Sternoclavicular Joint, either after an injury to the shoulder, or insidiously, with no history of trauma.[10] A Sternoclavicular Joint sprain is a relatively rare sporting injury, which can range from a small sprain resulting in minimal pain and allowing ongoing activity, to a severe sprain resulting in significant pain, deformity and disability,[11]
Techniques[edit | edit source]
Treatment[edit | edit source]
A mild sprain usually gets better by resting the joint for two to three days. Ice packs can be placed on the sore joint for up to 15 minutes at a time during the first few days after the injury.Moderate sprains may require some help to get the joint back into position. Your Physical Therapist at Humpal Physical Therapy & Sports Medicine Centers may recommend a figure-eight strap wraps around both shoulders to support the SC joint. Patients with a moderate sprain may need to wear this type of strap for four to six weeks. The strap protects the joint from another injury and lets the injured ligaments heal and become strong again.
Osteoarthritis of the SC Joint usually responds to our Physical Therapy treatments, including rest, ice, and anti-inflammatory medications. If the symptoms of osteoarthritis do not respond to basic treatment over six to 12 months, our Physical Therapist may refer you for surgical evaluation.If you don't need surgery, our Physical Therapist will start you on range-of-motion exercises as pain eases, followed by a program of strengthening.
For post surgical treatment your surgeon may have you wear a sling to support and protect the shoulder for a few days. Then your Physical Therapist can begin your rehabilitation program. Our first few Physical Therapy treatments will focus on controlling the pain and swelling from surgery. Ice and electrical stimulation treatments may help. We may also use massage and other types of hands-on treatments to ease muscle spasm and pain.Physical Therapy can progress safely and quickly after a simple arthroscopic resection. Our treatments begin with range-of-motion exercises and gradually work into active stretching and strengthening. You need to avoid doing too much, too quickly.[12]
Resources[edit | edit source]
- Dutton, M. (2008). Orthopaedic: Examination, evaluation, and intervention (2nd ed.). New York: The McGraw-Hill Companies, Inc.
- Levangie, P.K. & Norkin, C.C. (2005). Joint structure and function: A comprehensive analysis (4th ed.). Philadelphia: The F.A. Davis Company.
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ Levangie, P.K. and Norkin, C.C. (2005). Joint structure and function: A comprehensive analysis (4th ed.). Philadelphia: The F.A. Davis Company.
- ↑ Allman, F.L. (1967). Fractures and ligamentous injuries of the clavicle and its articulation. J Bone Joint Surg. 49A:774-784.
- ↑ Dutton, M. (2008). Orthopaedic: Examination, evaluation, and intervention (2nd ed.). New York: The McGraw-Hill Companies, Inc.
- ↑ Levangie, P.K. and Norkin, C.C. (2005). Joint structure and function: A comprehensive analysis (4th ed.). Philadelphia: The F.A. Davis Company.
- ↑ Dutton, M. (2008). Orthopaedic: Examination, evaluation, and intervention (2nd ed.). New York: The McGraw-Hill Companies, Inc.
- ↑ Levangie, P.K. and Norkin, C.C. (2005). Joint structure and function: A comprehensive analysis (4th ed.). Philadelphia: The F.A. Davis Company.
- ↑ Conway, A.M. (1961). Movements at the sternoclavicular and acromioclavicular joints. Phys Ther Rev. 41: 421-432.
- ↑ Levangie, P.K. &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Norkin, C.C. (2005). Joint structure and function: A comprehensive analysis (4th ed.). Philadelphia: The F.A. Davis Company.
- ↑ Brody, L.T.:Shoulder. In: Wadsworth, C.(ed.)(2001). Current concepts of orthopedic physical therapy: Home study course. LaCrosse, WI: Orthopaedic Secion, APTA, Inc.
- ↑ Disorders of the sternoclavicular jointfckLRC. M. Robinson, BMEdSci, FRCS Ed(Orth and Trauma), Consultant Orthopaedic Surgeon1; P. J. Jenkins, MRCS Ed, Specialty Registrar,
- ↑ http://www.physioadvisor.com.au/16459150/sternoclavicular-joint-sprain-sc-joint-sprain-.htm
- ↑ http://www.humpalphysicaltherapy.com/Injuries-Conditions/Shoulder/Shoulder-Issues/Sternoclavicular-Joint-Problems/a~372/article.html