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. 2018 Aug;13(4):752-762.

Rehabilitation Following Sternoclavicular Joint Reconstruction for Persistent Instability

Catherine Logan, Amir Shahien  1 , Burak Altintas  2 , Peter J Millett
Affiliations

Rehabilitation Following Sternoclavicular Joint Reconstruction for Persistent Instability

Catherine Logan et al. Int J Sports Phys Ther. 2018 Aug.

Abstract

Background: Sternoclavicular (SC) joint instability is a rare injury, but one with profound implications given its proximity to vital structures and function as the only true articulation between the upper extremity and axial skeleton. The majority of SC joint instability can be treated non-operatively; however, there is a role for reconstruction in the presence of instability that results in pain and dysfunction that is refractory to conservative management or deformity resulting in functional impairment. Given the lack of inherent osseous stability at the sternoclavicular joint and the role of ligaments as primary stabilizers, surgical intervention with emphasis on ligament reconstruction may be recommended. Safe and effective rehabilitation is conducted through phase progression, with avoidance of premature stress to the healing soft tissue graft. The purpose of this clinical commentary is to provide the senior author's rehabilitation protocol, which utilizes the available scientific literature to inform phase content and progression.

Level of evidence: 5.

Keywords: clavicle; reconstruction; rehabilitation; return to sport; sternoclavicular joint.

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Figures

Figure 1.
Figure 1.
Native anatomy of the sternoclavicular joint. Used with permission of SAGE Publications, from Martetschlager F, Warth RJ, Millett PJ. Instability and degenerative arthritis of the sternoclavicular joint: a current concepts review. Am J Sports Med. 2014;42(4):999-1007, doi: http://journals.sagepub.com/doi/abs/10.1177/0363546513498990.
Figure 2.
Figure 2.
CT Scan of the Sternoclavicular Joint This coronal slice of a CT scan demonstrates an anterior dislocation of the right sternoclaviular joint. Used with permission of SAGE Publications, from Martetschlager F, Warth RJ, Millett PJ. Instability and degenerative arthritis of the sternoclavicular joint: a current concepts review. Am J Sports Med. 2014;42(4):999-1007, doi: http://journals.sagepub.com/doi/abs/10.1177/0363546513498990.
Figure 3.
Figure 3.
Sternoclavicular Joint Reconstruction The graft is shuttled through passing sutures in the tunnels in a figure-of-eight fashion and secured with non-absorbable, high strength sutures through the tendon knot.
Figure 4.
Figure 4.
a and 4b. External Rotation Stretch (4a) and Sleeper Stretch (4b) Controlled, gentle external rotation stretch with assistance via a ski pole (4a) and modified sleeper stretch to stretch the posterior capsule (4b).
Figure 5.
Figure 5.
a and 5b. Prone Scapular Stabilization Prone strengthening of the scapular stabilizers via shoulder and torso extension.
Figure 6.
Figure 6.
Proprioception An example of open kinetic chain proprioception while emphasizing scapular stabilization.
See this image and copyright information in PMC

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