Sternoclavicular Joint Stabilisation

The sternoclavicular joint (SCJ) is the joint where the collarbone meets the breastbone, at the base of the front of the neck. It is held together by strong ligaments, and it is the only bony joint between the arm and the trunk.

Sternoclavicular joint stabilisation, also called SCJ reconstruction, repairs or reconstructs those ligaments when they have been damaged. Ligament damage can follow an injury, particularly recurrent dislocations, or it can develop as a result of osteoarthritis in the joint.

The procedure

The damaged ligaments are repaired or reconstructed using a tendon graft. The graft is taken either from the patient (an autograft) or from a donor (an allograft).

Surgery is usually considered after conservative treatment has not worked, where there are recurrent or irreducible dislocations, or where there has been long-standing instability.

The operation is usually performed open, and occasionally arthroscopically. Around two hours of theatre time is typically booked.

Risks and complications

General surgical risks

• Bruising and haematoma. The amount of bruising varies from person to person. It is a normal part of healing and usually resolves quickly.
• Infection. A possible risk, usually treated with antibiotics.
• Deep vein thrombosis (DVT) and pulmonary embolism (PE). Blood clots in the leg or the lung. These can be serious if untreated, but the risk of harm is significantly reduced when they are treated promptly.
• Anaesthetic risk. This is discussed in detail with your anaesthetist before surgery. The risk of death under a general anaesthetic in Australia is approximately 1 in 100,000.
• Wound problems. Superficial wound problems can occur. Most need only a minor intervention.

Risks specific to this procedure

• Further surgery. The rate of re-operation after SCJ stabilisation is relatively high, because the procedure is complex and the joint is subject to constant load.
• Instability. The joint may remain unstable, or become unstable again.
• Osteoarthritis. Arthritis can develop in the sternoclavicular joint.
• Nerve and blood vessel injury. Important nerves and large blood vessels lie immediately behind the sternoclavicular joint, so injury to them is a recognised risk of operating in this area.

Before surgery

There are a number of things to organise while you are waiting for surgery. You will also be given detailed instructions to make the process as smooth as possible.

1. Confirm with your health fund that the hospital fee is covered by your policy.
2. Confirm the anaesthetist's fees.
3. Register your details with the hospital.
4. Read, complete and return the paperwork to Dr Cutbush's office.
5. Plan your transport to and from hospital. You will not be able to drive yourself home.
6. Arrange any pre-operative physiotherapy that has been recommended.
7. Arrange any pre-operative pathology that is required, such as blood tests.
8. Benzoyl peroxide 5% wash. Five applications in total, to reduce the risk of infection from Cutibacterium acnes. Use it twice daily for two days, then once more on the morning of surgery.
9. Hospital bag. Pack your regular medications in their original packaging, a loose button-up shirt, nightwear and toiletries. Bring your CPAP machine if you have sleep apnoea.
10. Blood thinners. Phone Dr Cutbush's office to confirm when to stop them.
11. Diabetic tablets. Phone your anaesthetist to confirm whether to stop them.
12. Confirm your admission details with the office one to two business days before surgery.

The day of surgery

• Your admission details are confirmed one to two business days before surgery. Make a note of your admission time, which can be as early as 6am, and your fasting time.
• If you are travelling from interstate or from a regional area, it is usually recommended that you stay in Brisbane the night before.
• When you arrive you complete admissions and then wait in the surgical waiting area. The anaesthetist consults with you briefly before your general anaesthetic.
• Dr Cutbush greets you in the anaesthetic bay and marks the operation site with you.
• The hospital stay is usually one night. Discharge is typically around 10am, after Dr Cutbush has reviewed you.
• You are given a folder containing a letter describing what was found and what was done during surgery, along with rehabilitation and post-operative care information.
• Arrange for someone to take you home.

Recovery and healing

• Immobilisation. Six weeks in a sling, full time.
• Permitted movement. Gentle elbow, wrist and hand movement only.
• Restrictions. No driving and no physical activity. You will need time off work.
• Full recovery. Once the sling comes off and physiotherapy starts, full recovery generally takes five to six months. The timeframe depends on individual factors.

Rehabilitation

Physiotherapy progresses from gentle range of motion work in the early stages to strengthening in the later stages, preparing the shoulder girdle for a return to normal activities.

Day one

The hospital physiotherapist demonstrates how to fit the sling and how to eat, shower and dress while wearing it. You should be clear on these before you leave hospital.

Phase one: early healing (protective phase)

• Principle. The new collagen in the graft and the repair needs time to heal. Gentle stresses help guide the orientation of the new fibres, so shoulder girdle motion is limited, with no loading, pushing, pulling or carrying.
• Sling. Worn at all times except when washing or doing your exercises.
• Activities of daily living. Follow the advice you are given on the ward.
• Scapula. No elevation, depression, protraction or retraction. Postural setting is allowed, but not large scapular rolls, which would create excessive movement at the sternoclavicular joint.

Exercises

The exercises taught in hospital are:

• Cervical spine range of motion.
• Elbow flexion and extension, with the arm at your side.
• Active range of motion at the wrist and hand.
• Shoulder pendulums to 60 degrees, keeping the scapula positioned so that the arm is not dragged forward.
• Active or active-assisted external rotation with the arm at your side, to 40 degrees as tolerated.
• Local icing.

Follow-up

You see your local physiotherapist in weeks one to two. Your exercises do not change unless Dr Cutbush advises otherwise.

Results after surgery

Published series report improvement in pain and function after sternoclavicular joint stabilisation, and many patients return to their previous activity level. Individual results vary.

A small proportion of patients have persistent instability or need further surgery. Because this is a complex reconstruction in a joint that is loaded constantly, the rate of further surgery is higher than for most other shoulder operations.

Next steps

• Shoulder anatomy
• Shoulder instability
• Surgery FAQs
• Accommodation for interstate and regional patients
• Book a consultation

This page is general information about a surgical procedure and is not a recommendation that you have it. Whether surgery is appropriate for you can only be determined after assessment. All surgery carries risk; the risks relevant to you are discussed in consultation before any decision is made.