The Procedure
Sternoclavicular joint stabilisation, aka. SCJ stabilisation or SCJ reconstruction, is a procedure where ligaments in the sternoclavicular joint are repaired or reconstructed. The ligaments can become damaged after injuries, particularly recurrent dislocations, or from osteoarthritis. The surgery involves using tendon grafts, either from the patient’s own body (autografts) or from a donor (allograft), to repair or reconstruct the ligaments.
The procedure can be considered after conservative treatment has failed, if recurrent or irreducible dislocations occur, or if long-standing instability is present.
The procedure is typically performed in an open technique, though it can be done arthroscopically in some circumstances. I usually book about two hours of time in the operating theatre.
Complications
General risks of surgery include:
- Bruising & haematoma: this will vary for each patient. Bruising is a normal side effect of surgery and usually resolves in a short time.
- Infection: infection is a possible risk and is usually treated with antibiotics.
- DVT and PE: deep vein thrombosis and pulmonary embolism are blood clots that form in either the lower limbs or lungs. If left untreated, DVT and PE can have serious effects, however if treated promptly, the risks are significantly lowered. More information can be found here.
- Anaesthetic risks: general anaesthetic (GA) carries a number of risks, which will be discussed in detail with your anaesthetist prior to surgery. Fortunately, Australia is one of the safest places to undergo a GA. In Australia, the risk of mortality from GA is around 1 in 100,000. For context, the risk of death in a car accident in Queensland is around 1 in 10,000 per year.
- Wound issues: some superficial issues can develop in surgical wounds postoperatively, however most will require a small intervention to resolve the problem.
Specific risks of SCJ stabilisation include:
- Re-operation: SCJ stabilisation has quite a high rate of reoperation, due to the complex nature of the procedure
- Instability
- Osteoarthritis in the SCJ
- Nerve and blood vessel injuries
Pre Op
Whilst you wait for your surgery date, there are a few things to do:
- Speak to your health fund to confirm if the hospital fee for your surgery is covered on your policy
- Speak to your anaesthetist to confirm their fees
- Register your details with the hospital
- Read through, complete and return your paperwork to my office
- Plan your transport to and from the hospital. You won’t be able to drive yourself home after the surgery, so make sure you have a travel plan in place
- If required, arrange any recommended pre op physio appointments
- If required, get any pre op pathology tests (e.g., blood tests)
- Use benzoyl peroxide 5% wash on your shoulder for 5 applications: twice a day for two days, and then again on the morning of the surgery. This will help reduce your risk of infection from Cutibacterium acnes.
- Pack a bag for your hospital stay including regular medications in the original packaging, a loose button-up shirt to wear after surgery, nightwear, personal items including toiletries. If you have sleep apnoea, you must bring your CPAP machine.
- If you are on any blood thinners, ring my office and confirm when to stop taking them before the operation.
- If you are on any diabetic tablet medications, ring your anaesthetist and confirm whether you need to stop taking them before the operation.
- Confirm your admission details with my office one to two business days prior to surgery.
Though this can seem overwhelming, you will be provided with detailed instructions on what needs to be done so your surgery journey can be as smooth as possible.
Day of Surgery
Your admission details will be confirmed one to two business days prior to surgery. You will need to make note of your admission time and your fasting time. Your admission time may be as early as 6am. If you aren’t local to Brisbane, it is usually recommended that you stay the night before in case your admission is early.
When you arrive at the hospital, you will go through the admissions process and then be taken through to the surgical waiting area. Your anaesthetist will have a short consultation with you before you go into theatre and under general anaesthetic. I will say hi to you before the surgery in the anaesthetic bay of the operating theatre and mark your operation site with you.
Your hospital stay will usually be one night. You will be discharged usually around 10am. I will see you before your discharge. I will provide you with a folder containing a detailed postoperative pack including a letter telling you what I found at surgery and exactly what I did in your operation along with information about your rehabilitation and postoperative care. Remember to have someone available to take you home from the hospital.
Post Op Recovery & Healing
Following SCJ Stabilisation, recovery involves immobilisation of the shoulder, requiring six weeks of wearing a sling full time. During this time, only gentle movements of the elbow, wrist and hand are allowed, and driving and physical activities are not permitted. Time off work will also be required.
Once the sling is no longer required, and physiotherapy commences, full recovery generally takes 5 to 6 months, however individual factors will influence the timeline of returning to normal physical activities.
Rehabilitation
Following SCJ stabilisation, physiotherapy programs focus on improving mobility through gentle range of motion exercises, and then progress onto strengthening exercises in the later stages of rehabilitation to prepare for a return to normal activities.
Physiotherapy Guidelines
Day 1 Physiotherapy Guidelines
The hospital physio will demonstrate how to fit your sling and how to eat, shower & dress whilst in your sling. Please make sure you go through these things with the physio so that you get them really clear in your mind before you leave hospital.
Day one (PHASE ONE – Early Healing Protective Phase)
- Education and precautions – “protective phase"
- New collagen network requires time to heal with gentle stresses to positively affect fibre orientation therefore limited motion of the shoulder girdle with no load/push/pull/carry
- Immobilisation in sling at all times other than washing or doing exercises
- ADL (activities of daily living) advice
- No Scapula elevation/depression/protraction/retraction
Patient seen day one in hospital:
- Education and precautions “protective phase”
- Sling don/doff, correct fit of sling, demonstrate activities of daily living (showering, dressing etc)
- CSp ROM (cervical spine range of motion)Scapula postural setting but no large rolls of scapula which will create excessive motion at the SC (sternoclavicular) joint
- Elbow E/F with arm by side, Wrist/Hand AROM (active range of motion)
- Shoulder pendulum to 60 degree, ensuring patient maintains scapula posturing so not to allow drag of the arm forward
- Shoulder A/AA ER (active/active-assisted external rotation) with arm by side to 40 degrees as tolerated
- Local icing
Follow up:
- See local physiotherapist week 1-2 with good understanding of post op rehab guidelines and precautions, no change in exercises unless advised by me.
Results After Surgery
SCJ stabilisation surgery is typically successful in improving pain and function in patients, with many patients returning to previous levels of activity. A small rate of patients experience persistent instability or require further surgeries, however individual factors will influence this.