subluxing bilateral sternoclavicular joints

[vaultusa]

hello. my name is megan, this is my first time actually trying to use the internet for some help with my condition.

28/f bilateral subluxing SC joints. they seem to "come out of joint" about 20 minutes after being awake and up. through out the day, they continue to hurt and cause what i call "victim muscle pain" around my scapulae and where my neck connects to my shoulder.

i have had xrays, CT, and MRI. My PCP said that my CT was normal. But when i went to get the results when i was on my way back to the ortho for the 2nd time, I actually read the report.

Indication: Difficulty moving left arm, prominence of left sternoclavicular junction with episodes of feeling dislocated joint that needs manual reduction before the patient can move the left upper extremity.

Comparison: None.

Technique: Using a CT spiral scanner, multiple axial images of the sternoclavicular/limited thorax were obtained at 5 mm intervals without contrast.

Findings: Bilateral sternoclavicular joints are abnormal, with calcification and ossification inferior to the joints bilaterally, with a few small fragments. This is more prominent on the left side, despite a rather normal alignment of the joint on the current exam. The sternum appears to extend with ossification over the anteroinferior aspect of the left sternoclavicular junction, best seen on images #30-36. The first costochondral junction also shows evidence for prominent cartilage calcification. The sternum is intact and shows no abnormality otherwise. Retrosternal space is normally seen and no definite sternoclavicular dislocation on the current exam, is identified.

The visualized soft tissue structures and upper thorax, show no abnormality, except for a few non-specific bilateral axillary lymph nodes. Aortic arch is normally visualized and the superior mediastinal structures are unremarkable.

Impression: Abnormal bilateral sternoclavicular joints, more so on the left, may represent findings due to chronic degenerative processes with normal alignment on the current exam.

This CT was back in early 2007, and after seeing multiple doctors, i gave up on what to do. my internet findings tell me the SC joint is the "unfixable joint" and I am stuck with my pain. The ortho wanted to just try cortisone shots in my shoulder capsule, but that wasn't where the problem was coming from and didn't just want to "try" something. the cardiothorasic surgeon said he would fuse the joint or remove my clavicle, but he didn't really want to do either.

As of 6 months ago, the problem is now bilateral, and I have not had another CT done.

does anyone have any guidance at all ?? what can i do to not be in pain every day all day?

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[Musculoman]

Hay Vaultusa

I am no expert at SC joint injuries I am sorry to say, but I might be able to provide you with a little information.

Your SC joint is the only bone on bone joint connection of your arm to your main skeleton! The other interaction is in your scapula posteriorly. Occasionally I have found in clients with long term SC degeneration or damage a change in biomechanics and loading patterns which makes more use of their scapula and scauplothoracic (what us therapists call the connection between the back of your rib cage and your scapula) joint. This can overload your local muscles posteriorly and give you this tightness and pain you call "victim pain".

I am quite interested in your investigations, as the report states abnormal joints bilaterally. If you could post some of them in this topic we might be able to get a clearer picture of what is going on. Sadly however, in my limited experience SC joint injuries are generally quite passive in terms of their rehabilitation. Anti-inflams / pain relief etc. tend to be the trend from Dr's, unless their is clear evidence of dislocation, in which they can perform closed reduction (pop the joint back in) or open reduction (surgery).

I know you said it sounds like a dislocation as well, but by the sounds of the report it is more so degeneration following a possible trauma / dislocation? Were you in a car accident or something similar? This is the most common reasons for SC joint injuries. If this is the case it is likely that surgical intervention could be indicated to clean / reshape the joints? If you search "sternoclavicular surgery" on google (not very reliable I know) you will find a few case studies of people with similar problems who have undergone surgery to restabilise and clear out joints following problems with SC pain and recurrent dislocations/degeneration. Have a read and maybe write a list of questions to ask your Dr. or orthopaedic surgeon to see if this avenue might be an option.

Sorry I can't give you any more direct treatment options, but as I said, I am not an expert on SC joints so I will leave this to another therapist if I can I will keep an eye on this post and try and help out though

[roycar]

hi megan.

have you ever been to see a physiotherapist regarding your pain?

you obviously have a definitive reason for being in pain, degenerative sc joints but i imagine there are probably a fair few associated issues that may be adding to your pain.

the whole shoulder girdle system (clavicle, sc joint, ac joint, scapula, scapulothoracic joint, shoulder joint) is quite complex and in order for it to function correctly requires that the particular joints have a certain amount of range of movement and that local stabilising muscles and larger moving muscles work in a particular pattern to allow us to move our arms while maintaining functional stability at each of the segments.

the sc joint really doesnt have any particular stabilising muscles of its own but it is certainly a possibility that if you were to focus on retraining altered muscle recruitment patterns around your shoulder while also re-educating your posture and treating areas of stiffness you may experience an improvement in your symptoms. in theory you would be trying to "offload" the sterno clavicular joint, to what extent this could be achieved i am not sure but it would make sense. the stronger you are along the kinetic chain that is the arm/shoulder/upper trunk the less force that the sc joint may be under.

things that i would look out for are poor posture (neck, scapulae, shoulder, thoracic spine etc), poor scapular control statically and dynamically through range, stiff thoracic spine, stiff first rib, weak deep neck flexors, weak serratus anterior, weak lower traps, tight anterior shoulder structures and on and on and on......

so basically i would be looking out for a lot of things!

i'd recommend that you do a bit of research and try and find a physiotherapist close to you who has experience and an interest in treating problems around the shoulder and neck. go for an assessment and see what they thnk. you really dont have anything to lose.