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Sternoclavicular Joint Injury

Sternoclavicular Joint Injury is a topic covered in the 5-Minute Emergency Consult.

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  • Sternoclavicular joint (SCJ) is the only joint that connects the upper limb to the trunk.
  • Among the least frequently injured joints in the body
  • Most commonly due to athletic or vehicular injuries
  • Congenital or spontaneous dislocation and subluxation are rarely seen
  • SCJ stability depends on ligamentous attachments, primarily anterior and posterior sternoclavicular ligaments, interclavicular ligament, and costoclavicular ligament


  • Injury to the SCJ can be from sprains, subluxations, or dislocations of the ligamentous structure
  • In sprains, ligamentous capsule remains intact
  • Subluxation occurs when sternoclavicular ligament ruptures while costoclavicular ligament remains intact
  • Complete ligamentous disruption leads to dislocation
  • The SCJ can dislocate anteriorly or posteriorly. A large force is required. A greater force is required to displace the clavicle posteriorly.
  • Direction of dislocation depends on the shoulder position:
    • Anterior dislocation more likely when the acromion is posterior to the manubrium.
    • Posterior dislocation more likely when the acromion is anterior to the manubrium.
  • Anterior dislocation is more common (more than 90% of dislocations):
    • Caused by a posteriorly directed force to the anterolateral aspect of the shoulder
    • Reciprocal anterior displacement of the medial clavicle
    • May be associated with pneumothorax, hemothorax, pulmonary contusion, and rib fractures
    • Subluxation and dislocation may occur spontaneously.
  • Posterior SCJ dislocation results from:
    • Anterior-to-posterior blow to the medial clavicle
    • Anteriorly directed force to the lateral aspect of the ipsilateral shoulder
    • A blow to the contralateral shoulder when the injured side is braced against an immobile object
  • Posterior dislocation is a surgical emergency:
    • Indications for immediate reduction:
      • Compression or tear of trachea, esophagus, or great vessels
      • Recurrent laryngeal nerve injury

Pediatric Considerations
  • The medial epiphyseal growth plates of the clavicles are last to ossify, and fuse between ages 22 and 25:
    • Until fusion, growth plate is the weakest part of the joint
  • Fractures through the medial epiphysis mimic SCJ dislocations:
    • Most commonly Salter–Harris type I or II fractures
    • True dislocations of the SCJ are extremely rare in children because of strong ligamentous attachments.

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Rosen, Peter, et al., editors. "Sternoclavicular Joint Injury." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307582/all/Sternoclavicular_Joint_Injury.
Sternoclavicular Joint Injury. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307582/all/Sternoclavicular_Joint_Injury. Accessed April 26, 2019.
Sternoclavicular Joint Injury. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307582/all/Sternoclavicular_Joint_Injury
Sternoclavicular Joint Injury [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 26]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307582/all/Sternoclavicular_Joint_Injury.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Sternoclavicular Joint Injury ID - 307582 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307582/all/Sternoclavicular_Joint_Injury PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -