Kiel John, Ponnarasu Subitchan, Kaiser Kimberly
University of South Florida Morsani College of Medicine
Ramaiah Medical College & Hospitals, Bangalore, India
Sternoclavicular (SC) joint injuries are uncommon. The sternoclavicular joint is a diarthrodial joint composed of the sternum and clavicle. It is stabilized by the posterior capsular ligament which provides the most anterior-posterior stability and the anterior sternoclavicular ligament which restricts superior displacement. The costoclavicular ligament helps provide medial clavicle and anterior first rib stability. The interclavicular ligament passes over the sternum to provide medial traction of both clavicles. The inter-articular disc ligament attaches to the first rib and also provides stability of the sternoclavicular joint. In between the two articular surfaces and within the joint space is a fibrocartilaginous articular disc which functions as an important shock absorber. It is the only synovial articulation between the upper limb and axial skeleton. The subclavius muscle also supports the integrity of the joint. There are vital anatomic structures behind the clavicle which include the innominate artery and vein, vagus nerve, phrenic nerve, internal jugular vein, trachea, and esophagus. The medial clavicle physis appears in late adolescence and does not ossify until the age of 25. Movement of the joint occurs from transmission of movement from the scapula and the rest of the shoulder girdle. In abduction, the sternoclavicular joint has 35 degrees of range. Anterior-posteriorly it can move 70 degrees. There is also a rotational component. Injuries to the sternoclavicular joint can be traumatic or atraumatic. In traumatic injuries, the mechanism is usually a high energy injury such as a motor vehicle accident or injury during contact or collision sports. A sprain of the joint can occur when no laxity or instability occurs. Anterior dislocation is more common than posterior, which are associated with greater morbidity due to adjacent mediastinal and vascular structures. Atraumatic subluxations occur in younger patients with overhead elevation of the arm. This most commonly affects adolescent females with multidirectional instability. The subluxation is often painless and does not affect activities of daily living. It can be associated with trapezius palsy or spinal accessory nerve palsy.
胸锁关节损伤并不常见。胸锁关节是一个由胸骨和锁骨组成的动关节。它由后关节囊韧带稳定，该韧带提供最大的前后稳定性，以及胸锁前韧带，该韧带限制向上移位。肋锁韧带有助于提供锁骨内侧和第一肋前部的稳定性。锁骨间韧带越过胸骨以提供两侧锁骨的内侧牵引力。关节盘韧带附着于第一肋，也提供胸锁关节的稳定性。在两个关节面之间以及关节间隙内是一个纤维软骨关节盘，其作为重要的减震器发挥作用。它是上肢与中轴骨骼之间唯一的滑膜关节。锁骨下肌也支持关节的完整性。锁骨后方有重要的解剖结构，包括无名动脉和静脉、迷走神经、膈神经、颈内静脉、气管和食管。锁骨内侧骨骺在青春期后期出现，直到25岁才骨化。关节的运动通过肩胛骨和肩带其他部分的运动传递而发生。在肩关节外展时，胸锁关节有35度的活动范围。前后方向可移动70度。还有一个旋转成分。胸锁关节损伤可分为创伤性或非创伤性。在创伤性损伤中，机制通常是高能量损伤，如机动车事故或接触性或碰撞性运动中的损伤。当没有松弛或不稳定发生时，关节可能会发生扭伤。前脱位比后脱位更常见，由于相邻的纵隔和血管结构，后脱位的发病率更高。非创伤性半脱位发生在手臂过度上举的年轻患者中。这最常见于具有多向不稳定的青春期女性。半脱位通常无痛，不影响日常生活活动。它可能与斜方肌麻痹或副神经麻痹有关。
