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Picture

Arthrokinematics of the Sternoclavicular Joint

1/26/2018

5 Comments

 
This past week I had a patient that presented with left upper quarter pain following a traction injury to her left arm as her dog yanked her arm forward. The pain was located over her left clavicular region and anterior to left scapula. My examination revealed hypomobility over her left ribs 2-3 and left sternoclavicular (SC) joint as her primary restrictions (both of which reproduced her pain when assessed). She has made excellent progress just in the treatment from the first day with joint mobilizations of the SC joint and and ribs. With reflecting upon this patient, I thought it would be great to review some of the anatomy and arthrokinematics for the SC joint.
​Anatomy of Sternoclavicular Joint
The SC joint is made up of the medial end of the clavicle, the manubrium and an articular disc in-between. It is important to understand that the sternoclavicular joint is a saddle joint. It gets its name from the shape as it has a concave surface in one direction and convex in another, like a saddle. The medial aspect of the clavicle is concave anterior-to-posterior and convex superior-to-inferior. The manubrium has the reciprocal joint surface. The result is that with protraction/retraction, the sternum rolls and glides anteriorly and posteriorly, respectively speaking, and with elevation and depression, the clavicle rolls and slides opposite (roll superiorly and slide inferiorly with elevation; opposite for depression). Additionally, there is some posterior rotation of the clavicle that occurs with elevation and anterior rotation with extension.
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When it comes to assessing and treating joint restrictions in the SC joint, I try to keep it simple. Assess the mobility in each direction and mobilize into the restriction. It's possible you'll note some hypermobility in a certain direction (you don't want to increase mobility there). Often, you will note that the restricted aspect of the joint may correlate with physiological motion deficits in the shoulder; however, that is not a rule of presentation. To make matters simpler, stick with finding the restricted direction and mobilizing it. For more information on the anatomy and biomechanics of the SC joint, check out the videos below!

​-Dr. Chris Fox, PT, DPT, OCS

SEE MORE FROM TSPT:
- Return to Sport Testing
-Lateral Movement Progressions and Regressions
- Advanced Throwers Exercises
- ACL Sport Rehab Pearls
- Advanced Hamstring Exercises
​- And MORE! 
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5 Comments
Lasse Liikanen
8/14/2018 03:57:48 am

"The result is that with protraction/retraction, the sternum rolls and glides anteriorly and posteriorly.."

Do you mean clavicle rolls?

Reply
mike levrini
3/3/2020 10:40:58 am

Where can I find authoritative information on the biomechanics/arthrokinematics of the sternoclavicular joint and shoulder as a whole? I had a hyperabduction and shoulder retraction injury of my shoulder and now having trouble throwing a softball. I intermittently throw the ball into the ground. MRI shows a slightly displaced disc along with degenerative changes. I am 69 years old.

Thanks

Reply
miles Tompkins
10/31/2022 06:01:17 am

I'm interested in the position of the displacement. I suspect a forward flexed clavicle....that can be reduced quite easily..with a period of rest following..... if its forward flexed...it will not rotate weel when in elevation...

https://yourolddog.com/ link
8/5/2022 05:14:19 am

The first thing that you need to do when it comes to buying dog food is to know what your dog is eating. There are many different kinds of dog food available in the market today, and each one has its own unique features. You also have to consider your budget when buying dog food because this will help you choose what kind of diet you want for your pet

Reply
Dr Michael G Levrini
10/31/2022 01:18:43 pm

Yes, I believe it is anteriorly displaced from the hyperabduction/retraction of my right shoulder. I sometimes clicks when I move the shoulder such as when throwing a ball. As I said previously, I intermittently throw a ball terribly whereby the ball goes into the ground. Embarrassing when I played on a softball team. Forced me to throw underhand when I could or from the side. I get no pain.

Reply



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  • Home
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  • Resources
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    • Special Tests >
      • Cervical Spine >
        • Alar Ligament Test
        • Bakody's Sign
        • Cervical Distraction Test
        • Cervical Rotation Lateral Flexion Test
        • Craniocervical Flexion Test (CCFT)
        • Deep Neck Flexor Endurance Test
        • Posterior-Anterior Segmental Mobility
        • Segmental Mobility
        • Sharp-Purser Test
        • Spurling's Maneuver
        • Transverse Ligament Test
        • ULNT - Median
        • ULNT - Radial
        • ULNT - Ulnar
        • Vertebral Artery Test
      • Thoracic Spine >
        • Adam's Forward Bend Test
        • Passive Neck Flexion Test
        • Thoracic Compression Test
        • Thoracic Distraction Test
        • Thoracic Foraminal Closure Test
      • Lumbar Spine/Sacroiliac Joint >
        • Active Sit-Up Test
        • Alternate Gillet Test
        • Crossed Straight Leg Raise Test
        • Extensor Endurance Test
        • FABER Test
        • Fortin's Sign
        • Gaenslen Test
        • Gillet Test
        • Gower's Sign
        • Lumbar Quadrant Test
        • POSH Test
        • Posteroanterior Mobility
        • Prone Knee Bend Test
        • Prone Instability Test
        • Resisted Abduction Test
        • Sacral Clearing Test
        • Seated Forward Flexion Test
        • SIJ Compression/Distraction Test
        • Slump Test
        • Sphinx Test
        • Spine Rotators & Multifidus Test
        • Squish Test
        • Standing Forward Flexion Test
        • Straight Leg Raise Test
        • Supine to Long Sit Test
      • Shoulder >
        • Active Compression Test
        • Anterior Apprehension
        • Biceps Load Test II
        • Drop Arm Sign
        • External Rotation Lag Sign
        • Hawkins-Kennedy Impingement Sign
        • Horizontal Adduction Test
        • Internal Rotation Lag Sign
        • Jobe Test
        • Ludington's Test
        • Neer Test
        • Painful Arc Sign
        • Pronated Load Test
        • Resisted Supination External Rotation Test
        • Speed's Test
        • Posterior Apprehension
        • Sulcus Sign
        • Thoracic Outlet Tests >
          • Adson's Test
          • Costoclavicular Brace
          • Hyperabduction Test
          • Roos (EAST)
        • Yergason's Test
      • Elbow >
        • Biceps Squeeze Test
        • Chair Sign
        • Cozen's Test
        • Elbow Extension Test
        • Medial Epicondylalgia Test
        • Mill's Test
        • Moving Valgus Stress Test
        • Push-up Sign
        • Ulnar Nerve Compression Test
        • Valgus Stress Test
        • Varus Stress Test
      • Wrist/Hand >
        • Allen's Test
        • Carpal Compression Test
        • Finkelstein Test
        • Phalen's Test
        • Reverse Phalen's Test
      • Hip >
        • Craig's Test
        • Dial Test
        • FABER Test
        • FAIR Test
        • Fitzgerald's Test
        • Hip Quadrant Test
        • Hop Test
        • Labral Anterior Impingement Test
        • Labral Posterior Impingement Test
        • Long-Axis Femoral Distraction Test
        • Noble Compression Test
        • Percussion Test
        • Sign of the Buttock
        • Trendelenburg Test
      • Knee >
        • Anterior Drawer Test
        • Dial Test (Tibial Rotation Test)
        • Joint Line Tenderness
        • Lachman Test
        • McMurray Test
        • Noble Compression Test
        • Pivot-Shift Test
        • Posterior Drawer Test
        • Posterior Sag Sign
        • Quad Active Test
        • Thessaly Test
        • Valgus Stress Test
        • Varus Stress Test
      • Foot/Ankle >
        • Anterior Drawer
        • Calf Squeeze Test
        • External Rotation Test
        • Fracture Screening Tests
        • Impingement Sign
        • Navicular Drop Test
        • Squeeze Test
        • Talar Tilt
        • Tarsal Tunnel Syndrome Test
        • Test for Interdigital Neuroma
        • Windlass Test