Sternoclavicular Joint (SCJ)

Authors

Affiliations

Nate Yomogida, PT, DPT

Doctor of Physical Therapy

B.S. in Kinesiology

Chloë Kerstein, PT, DPT

Doctor of Physical Therapy

B.A. in Neuroscience

Figure 1: Sternoclavicular joint (Anterior view)¹

The sternoclavicular joint is a synovial saddle joint

Muscles

Connective tissue

Joint Structure

Since the SCJ is a saddle joint, both the distal and proximal joint surfaces have concave and convex facets.

• Frontal plane:
  • Convex clavicle on Concave sternum
  • Superior roll and inferior slide
• Transverse plane:
  • Concave clavicle on convex sternum
  • Anterior roll and slide
• 6° upward slope
• Posterior to the frontal plane 20 deg

Capsule

The capsular pattern of the SCJ is the same as the ACJ². There is no true capsular pattern of the SCJ, but a capsular dysfunction could present as decreased horizontal adduction or decreed end-range of motion in all movements².

Kinematics

The sternoclavicular joint has 3 degrees of freedom:

1. Frontal plane: Elevation & Depression
2. Transverse plane: Protraction & Retraction
3. Sagittal plane: Anterior rotation and Posterior rotation

These movements combine to place the scapula in a position to optimally accept the head of the humerus³. As a result, all of the functional movements at the glenohumeral joint involve SCJ movement.

The SCJ is a saddle joint, meaning that its convex-concave surfaces are contingent on which plane of motion you are observing:

• In the frontal plane (elevation and depression) there is a convex clavicle moving on a concave sternum.
  • Elevation: Superior roll, inferior slide of the clavicle on the sternum
  • Depression: Inferior roll, superior slide of clavicle on sternum
• During protraction and retraction the SCJ consists of a concave clavicle moving on a convex sternum
  • Protraction: Anterior roll + Anterior glide of clavicle on sternum
  • Retraction: Posterior roll + posterior slide of clavicle on sternum

Elevation

• The SCJ has 35-45° of elevation³.
  • Endrange elevation is limited by the costoclavicular ligament.

In open kinetic chain, elevation involves the movement of the convex clavicle on the concave sternum. As a result, the convex clavicle rolls superiorly and slides inferiorly³.

In closed chain, the concave sternum rolls superiorly and slides superiorly on the convex clavicle.

Depression

• The SCJ has ~10° of depression from neutral³.
  • Endrange depression stretches the interclavicular ligament and the superior portion of the capsular ligaments³.
• In Open kinetic chain, the convex clavicle rolls inferiorly and slides superiorly on the concave sternum³.
• In closed chain, the concave sternum rolls and slides inferiorly on the convex clavicle.

Protraction

• Protraction and retraction both have ~15-30° from neutral³.

• This movement occurs in the transverse or horizontal plane around the vertical axis of rotation³.

• During open kinetic chain protraction, the concave clavicle rolls and slides anteriorly on the convex sternum³.

• Closed chain protraction involves the convex sternum rolling anteriorly and sliding posteriorly.

This movement is limited by:

• Posterior bundle of the costoclavicular ligament
• Posterior capsular ligament of the SC joint³
• Scapular retractor muscles³
  • Rhomboid major
  • Rhomboid minor
  • Middle trapezius

Retraction

• This movement occurs in the transverse or horizontal plane around the vertical axis of rotation³.
• Protraction and retraction both have ~15-30° from neutral³.
  • Endrange retraction stretches the anterior bundles of the costoclavicular ligament and the anterior capsular ligaments³.
• During open kinetic chain retraction, the concave clavicle rolls and slides posteriorly on the convex sternum³.
• Closed chain retraction involves the convex sternum posteriorly rolling and anteriorly sliding on the concave clavicle.

Anterior rotation

• Refers to rotation around the longitudinal axis³

Posterior rotation

• Refers to rotation around the longitudinal axis³.
• The SCJ can perform ~20-35° of posterior rotation³.
• This motion involves arthrokinematic spin and does not follow the convex-concave rule³.
• Posterior rotation is important in posterior tilt of the scapulothoraic joint.

This motion is important during full flexion and abduction of the shoulder³.

Functional movements

The clavicle and therefore the SCJ requires rotation in all 3 degrees of freedom when raising the arm overhead³.

Palpation

To palpate the sternoclavicular joint:

• Locate the suprasternal notch, which can be found on the superior aspect of the manubrium⁴.
• Move laterally from the suprasternal notch to the sternoclavicular joint⁴.
• Alternating elevation and depression of the shoulder while palpating the joint will help you to clearly distinguish between the manubrium and the clavicle⁴.

Note

At the sternoclavicular joint, the clavicle is raised slightly above the manubrium at the articulation⁴.

Stabilization

Tissues that stabilize the SCJ:

Passive Stabilizers

• Anterior sternoclavicular joint ligament³
• Posterior sternoclavicular joint ligament³
• Interclavicular ligament³
• Costoclavicular ligament³
• Articular disc³

Active Stabilizers

• Subclavius^2,3,5
• Sternocleidomastoid³
• Sternothyroid³
• Sternohyoid³

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Table 1: Sternoclavicular joint stabilizer muscles

Muscle	Origin	Insertion	Innervation	Action
Sternocleidomastoid	Manubrium Medial third of Clavicle	Mastoid process Superior nuchal line	CN XI Accessory n. Cervical plexus C1 - C4	Unilateral: I/L cervical sidebend, C/L cervical rotation Bilateral: Head extension, Cervical Flexion, Assists in respiration, Prevents posterior translation during mastication SCJ stabilization
Sternohyoid				SCJ: Stabilization
Sternothyroid				SCJ: Stabilization
Subclavius	1st rib	Clavicle (inferior surface)	N. to subclavius C5 - C6	SCJ: Stabilization

Clinical Significance

Biomechanical studies have shown a variation of 15-31 degrees in the SC joint through the rotation of the clavicle during the movements of the arm in the frontal plane (abduction) and less in the sagittal plane (flexion)⁶ (Ludewig et al. 2004)

Clinical Presentation

AROM limitations - ABD is most limited when missing a clavicle

Joint Mobilization

Anterior mobilization

An anterior mobilization of the SCJ is indicated for patients who have both passive and active protraction ROM limitations due to structural impairments⁷.

Technique

• Patient position: supine
• Face the patient
• Hook the pads of fingers 2-5 on the posterosuperior aspect of the clavicle
• Place both thumbs on the posteroinferior aspect of the clavicle

Apply an anterior mobilization by pulling the clavicle anteriorly⁷.

Posterior Glide

A posterior mobilization is indicated to improve retraction range of motion⁷. A posterior mobilization of the SCJ is indicated for patients who have both passive and active retraction ROM limitations due to structural impediments⁷.

Technique

• Face the patient
• Place the inside thumb on the anterior and proximal aspect of the clavicle⁷.
• Place the dorsal surface of the middle phalanx of the index finger just inferior to your thumb to add support⁷.

Apply a posterior mobilization by pushing your thumb finger in a posterior direction⁷.

Superior mobilization

A Superior glide is indicated for patients with limited passive and active ROM deficits for SCJ depression⁷.

Technique

• Face the patient
• Place the inside thumb on the anterior and proximal aspect of the clavicle⁷.
• Place the dorsal surface of the middle phalanx of the index finger on the inferior surface of the clavicle⁷.

Apply a superior mobilizing Force by pushing your index finger in a superior direction⁷.

Inferior mobilization

An inferior mobilization of the SCJ is indicated for patients who have both passive and active elevation ROM limitations due to structural impairments⁷.

Supine technique

• Patient position: supine
• Face the patient
• Hook the pads of fingers 2-5 of both hands on the superior aspect of the clavicle
• Place both thumbs on the inferior aspect of the clavicle

Apply an inferior mobilization by pulling the clavicle inferiorly⁷.

References

1.

Gray H. Anatomy of the Human Body. 20th ed. (Lewis WH, ed.). Lea & Febiger; 1918. https://www.bartleby.com/107/

2.

Dutton M. Dutton’s Orthopaedic Examination, Evaluation, and Intervention. 5th ed. McGraw Hill Education; 2020.

3.

Neumann DA, Kelly ER, Kiefer CL, Martens K, Grosz CM. Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation. 3rd ed. Elsevier; 2017.

4.

Finando D, Finando SJ, Finando D. Trigger Point Therapy for Myofascial Pain: The Practice of Informed Touch. Healing Arts Press; 2005.

5.

Gilroy AM, MacPherson BR, Wikenheiser JC, Voll MM, Wesker K, Schünke M, eds. Atlas of Anatomy. 4th ed. Thieme; 2020.

6.

Ludewig PM, Behrens SA, Meyer SM, Spoden SM, Wilson LA. Three-dimensional clavicular motion during arm elevation: Reliability and descriptive data. The Journal of Orthopaedic and Sports Physical Therapy. 2004;34(3):140-149. doi:10.2519/jospt.2004.34.3.140

7.

Kisner C, Colby LA, Borstad J. Therapeutic Exercise: Foundations and Techniques. Seventh edition. F.A. Davis Company; 2018.