Sternoclavicular Joint (SCJ)

Authors

Affiliations

Nathaniel Yomogida, B.S., SPT

Doctor of Physical Therapy

B.S. in Kinesiology

Chloë Kerstein, B.S., SPT

Doctor of Physical Therapy

B.A. in Neuroscience

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

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 humerus¹. As a result, all of the functional movements at the glenohumeral joint involve SCJ movement.

Elevation

• The SCJ has 35-45° of elevation¹.
  • 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 inferiorly¹.

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

Depression

• The SCJ has ~10° of depression from neutral¹.
  • Endrange depression stretches the interclavicular ligament and the superior portion of the capsular ligaments¹.
• In Open kinetic chain, the convex clavicle rolls inferiorly and slides superiorly on the concave sternum¹.
• In closed chain, the concave sternum rolls and slides inferiorly on the convex clavicle.

Protraction

• Protraction and retraction both have ~15-30° from neutral¹.

• This movement occurs in the transverse or horizontal plane around the vertical axis of rotation¹.

• During open kinetic chain protraction, the concave clavicle rolls and slides anteriorly on the convex sternum¹.

• 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 joint¹
• Scapular retractor muscles¹
  • Rhomboid major
  • Rhomboid minor
  • Middle trapezius

Retraction

• This movement occurs in the transverse or horizontal plane around the vertical axis of rotation¹.
• Protraction and retraction both have ~15-30° from neutral¹.
  • Endrange retraction stretches the anterior bundles of the costoclavicular ligament and the anterior capsular ligaments¹.
• During open kinetic chain retraction, the concave clavicle rolls and slides posteriorly on the convex sternum¹.
• Closed chain retraction involves the convex sternum posteriorly rolling and anteriorly sliding on the concave clavicle.

Anterior rotation

• Refers to rotation around the longitudinal axis¹

Posterior rotation

• Refers to rotation around the longitudinal axis¹.
• The SCJ can perform ~20-35° of posterior rotation¹.
• This motion involves arthrokinematic spin and does not follow the convex-concave rule¹.
• Posterior rotation is important in posterior tilt of the scapulothoraic joint.

This motion is important during full flexion and abduction of the shoulder¹.

Functional movements

The clavicle and therefore the SCJ requires rotation in all 3 degrees of freedom when raising the arm overhead¹.

Palpation

To palpate the sternoclavicular joint:

• Locate the suprasternal notch, which can be found on the superior aspect of the manubrium².
• Move laterally from the suprasternal notch to the sternoclavicular joint².
• Alternating elevation and depression of the shoulder while palpating the joint will help you to clearly distinguish between the manubrium and the clavicle².

Note

At the sternoclavicular joint, the clavicle is raised slightly above the manubrium at the articulation².

Stabilization

Tissues that stabilize the SCJ:

Passive Stabilizers

• Anterior sternoclavicular joint ligament¹
• Posterior sternoclavicular joint ligament¹
• Interclavicular ligament¹
• Costoclavicular ligament¹
• Articular disc¹

Active Stabilizers

• Subclavius^1,3,4
• Sternocleidomastoid¹
• Sternothyroid¹
• Sternohyoid¹

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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: Clavicular 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)⁵ (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 impairments⁶.

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 anteriorly⁶.

Posterior Glide

A posterior mobilization is indicated to improve retraction range of motion⁶. A posterior mobilization of the SCJ is indicated for patients who have both passive and active retraction ROM limitations due to structural impediments⁶.

Technique

• Face the patient
• Place the inside thumb on the anterior and proximal aspect of the clavicle⁶.
• Place the dorsal surface of the middle phalanx of the index finger just inferior to your thumb to add support⁶.

Apply a posterior mobilization by pushing your thumb finger in a posterior direction⁶.

Superior mobilization

A Superior glide is indicated for patients with limited passive and active ROM deficits for SCJ depression⁶.

Technique

• Face the patient
• Place the inside thumb on the anterior and proximal aspect of the clavicle⁶.
• Place the dorsal surface of the middle phalanx of the index finger on the inferior surface of the clavicle⁶.

Apply a superior mobilizing Force by pushing your index finger in a superior direction⁶.

Inferior mobilization

An inferior mobilization of the SCJ is indicated for patients who have both passive and active elevation ROM limitations due to structural impairments⁶.

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 inferiorly⁶.

References

1.

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

2.

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

3.

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

4.

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

5.

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

6.

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