SCJ Injury: Symptoms, Types, and When to Seek Medical Attention

What are the symptoms of a SCJ injury?

An SCJ injury typically presents with localized pain, swelling, and tenderness at the base of the neck where the collarbone meets the breastbone, often accompanied by limited arm movement, a visible deformity, or an audible clicking sensation.

Understanding the Sternoclavicular Joint (SCJ)

The sternoclavicular (SC) joint is a critical articulation connecting the sternum (breastbone) to the clavicle (collarbone). Although it is one of the smallest joints in the body, it plays a vital role in the overall mobility and stability of the shoulder girdle and upper extremity. As the only direct bony attachment of the upper limb to the axial skeleton, the SCJ acts as a strut, allowing for a wide range of arm movements while absorbing forces transmitted through the arm. Its stability is primarily provided by strong ligaments, including the anterior and posterior sternoclavicular ligaments, the interclavicular ligament, and the costoclavicular ligament.

Types of SCJ Injuries

Injuries to the SCJ are relatively uncommon but can range from mild sprains to severe dislocations. They typically result from direct trauma to the front of the chest or a force transmitted indirectly through the shoulder, such as a fall onto an outstretched arm or a direct blow during contact sports.

The most common types of SCJ injuries include:

• Sprains: Stretching or tearing of the ligaments supporting the joint. These are graded from I (mild) to III (severe, involving complete ligament rupture).
• Dislocations: When the end of the clavicle displaces from its normal position in the sternum. Dislocations can be:
  • Anterior Dislocation: The clavicle displaces forward, which is the most common type.
  • Posterior Dislocation: The clavicle displaces backward, a much rarer but potentially more serious injury due to its proximity to vital structures like the trachea, esophagus, and major blood vessels.

Primary Symptoms of an SCJ Injury

Recognizing the symptoms of an SCJ injury is crucial for timely diagnosis and appropriate management. The presentation can vary depending on the severity and type of injury.

1. Localized Pain

• Location: The most prominent symptom is pain directly over the SC joint, at the medial (inner) end of the clavicle where it meets the sternum.
• Nature: The pain can range from a dull ache in mild sprains to sharp, intense pain in dislocations.
• Aggravating Factors: Pain is typically worsened by:
  • Moving the arm across the body (adduction).
  • Raising the arm overhead (flexion or abduction).
  • Sleeping on the affected side.
  • Deep breathing, coughing, or sneezing, especially with posterior dislocations due to pressure on adjacent structures.
  • Direct pressure or palpation of the joint.

2. Swelling and Bruising

• Swelling: Visible swelling or puffiness around the SC joint is common, indicating fluid accumulation due to inflammation or bleeding within the joint capsule.
• Bruising (Ecchymosis): Discoloration of the skin around the joint may develop shortly after the injury, particularly with more severe sprains or dislocations where blood vessels are damaged.

3. Deformity or Prominence

• Anterior Dislocation: A visible lump or prominence may be observed at the front of the chest, where the clavicle has displaced forward. This is often the most obvious sign.
• Posterior Dislocation: While less obvious, there might be a subtle flattening or depression at the SC joint area. More critically, symptoms related to compression of underlying structures may be present (see below).

4. Reduced Range of Motion (ROM)

• Shoulder and Arm Movement: Patients will experience difficulty and pain when attempting to move the affected arm, particularly with overhead movements, reaching across the body, or lifting objects. This limitation is due to pain and the mechanical disruption of the joint.
• Head and Neck Movement: In some cases, especially with severe sprains or posterior dislocations, neck movements may also be restricted or painful due to muscle guarding or referred pain.

5. Clicking, Popping, or Grinding Sensation

• Audible or Palpable: Some individuals may hear or feel a clicking, popping, or grinding sensation (crepitus) within the joint during movement, especially when attempting to move the arm. This can indicate instability or rough surfaces within the joint.

6. Weakness

• Generalized Weakness: A general feeling of weakness in the affected arm and shoulder is common, largely due to pain inhibition and the inability to effectively stabilize the shoulder girdle.

7. Nerve or Vascular Symptoms (Crucial for Posterior Dislocation)

• Dysphagia (Difficulty Swallowing): Compression of the esophagus.
• Dyspnea (Difficulty Breathing) or Stridor (High-pitched Breathing Sound): Compression of the trachea.
• Hoarseness: Compression of the recurrent laryngeal nerve.
• Paresthesia (Numbness or Tingling): In the arm or hand, indicating compression of the brachial plexus (nerves).
• Vascular Compromise: Swelling, discoloration, or coolness of the arm and hand, indicating compression of the subclavian artery or vein. This is an emergency and requires immediate medical attention.

Differentiating SCJ Injury Severity by Symptoms

The intensity and combination of symptoms can often provide clues about the severity of the SCJ injury:

• Grade I Sprain (Mild): Mild pain, localized tenderness, minimal swelling. Full range of motion is usually possible, though painful at end ranges. No deformity.
• Grade II Sprain (Moderate): More significant pain, moderate swelling, and tenderness. Noticeable limitation in arm movement. Some mild instability may be present, but no complete dislocation.
• Grade III Sprain/Dislocation (Severe): Intense pain, significant swelling, and often a very obvious deformity (anterior dislocation). Marked limitation or complete inability to move the arm. Posterior dislocations present with less obvious deformity but potentially life-threatening compressive symptoms.

When to Seek Medical Attention

Any suspected SCJ injury warrants prompt medical evaluation. While mild sprains may resolve with rest and conservative management, differentiating between a sprain and a dislocation, especially a posterior one, is critical. A healthcare professional can perform a thorough physical examination, order imaging studies (such as X-rays, CT scans, or MRI) to confirm the diagnosis, and rule out more serious complications. Early and accurate diagnosis ensures the most appropriate treatment plan, preventing chronic pain, instability, or more severe health consequences.

Conclusion

The sternoclavicular joint, though small, is integral to shoulder function. Injuries to this joint, while relatively uncommon, can cause significant pain and functional limitation. Recognizing the hallmark symptoms—localized pain, swelling, deformity, and restricted movement—is the first step. For any suspected SCJ injury, particularly if there's an obvious deformity, severe pain, or any difficulty breathing or swallowing, immediate medical attention is paramount to ensure proper diagnosis and management, safeguarding both joint health and overall well-being.