Sternoclavicular Joint Injury

[Eddzzz]

Hi All,

Thank you for taking the time to look into my issue.

Approximately 4 months ago I fell off my pedal bike (20mph) and hit my shoulder hard on the ground. I had shoulder pain and rested for the next two weeks, then started swimming again for two weeks after which I noticed pain in my SC joint and a lump and figured it was caused because of the trauma to the shoulder joint from my bike accident, however never noticed it because of my shoulder pain which has since subsided at which point I stopped all sport and went to see the Doc. and he referred me for an X-Ray, which was all clear. For the past few months my SC joint becomes inflamed throughout the day (whilst at work, nothing too laborious but I do drive for an hour each way which could be irritating it) and usually eases in the evening and at night (When I wake up in the morning my SC joint is fairly flat and protrudes much less than later on during the day). Pain is minimal but again worsens as the day goes on and it "feels" as though it's on the tip of the clavicle on the SC joint. When I rotate my shoulder I can feel a "clicking" noise from my SC joint and I've tried to not reach above shoulder height, movement is not limited and pain is minor.

I have an appt. with the doctor again next week and I'm going to push for an MRI and some Physio Therapy.

Do you have any other recommendations on what I could do to help speed up recovery/ do differently? I'm putting a heat pad on multiple times a day too. It's to the point now where it's affecting my life (Avid climber, swimmer, cyclist...) but if it just takes time, it takes time and I don't want to push it and damage it further...

Many thanks,

Ed

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[sunitPhysio]

As per your description, most probably the pain is due to 'dislocation of SC joint'. It is very difficult to diagnose it through X-Ray investigation. It is because, it's difficult to visualise it through X-ray.

It can only be diagnosed through clinical sign. All your clinical symptoms points toward SC joint dislocation.
As you said you get relief on rest, your only treatment option is to give complete rest to this SC joint. This can be acheived by using "figure-of-8" bandage.

Hope this helps you. Best wishes.
Everything Physiotherapy

[Eddzzz]

Hi SunitPhysio,

Many thanks for your reply and confirming on what I think has happened - I'll try out the figure of 8 wrap and see how it goes.

Thanks,

Ed

[Eddzzz]

Hi All,

Just a quick update - I went to see an Orthopaedic consultant (10/2016) and he said it looked like a dislocation too. I asked if I could have an MRI to be sure and he said not a problem. I received an appointment with my orthopaedic consultant to discuss the results and it turns out that my clavicle is not dislocated (we looked through the MRI together and I'm waiting for a DVD with the images). I still have inflammation over the joint, however I notice that it is reduced in the morning when I've rested it overnight (Sometimes it has a similar prominence to my other SC joint). I've now returned back to the gym and started swimming. This aggravates something within the joint (ligament/ tendon/ cartilage?) slightly and it swells slightly with mild pain (2/10). What would you recommend as the next course of action? Review in another few months or do you think irreversible damage has happened and it's something I'll have to live with?

Many thanks,

Kris

[Eddzzz]

Further update - 1 year since initial accident. SC joint is exactly the same. Still swells up throughout the day and almost flat in the morning. Slight pain. No reduction in strength or movement. Don;t know what to do as it's starting to bug me now and I'm worried about the consequences further down the line. Any advice anyone?

Ed

[AgnesBird]

Hi Eddzzz,
I have similar story. I didn't have any injury but I overworked my shoulder then got a lump just under my SC joint then my shoulder became kind of loose. SC joint becomes more irritated with the course of the day. I visited chiropractic, osteopath. I started doing stabilising exercises to help my shoulder a little bit. It's now 3rd month since all has started and I can't see any improvement. I am swimmer too and can say for sure it does hurt a little bit more after swimming but it's nothing sharp or acute.

The only hope I found on the internet seems to be microperforation prolotherapy or Platelet Rich Plasma Injections or mix of both Have you tried maybe any of these?

I hope you are better off now. If you could give me update on your situation, I would appreciate. I am looking for solution myself.

Agnes

[Eddzzz]

Hi Agnes,

The lump is still there and the right SC joint is slightly higher and more pronounced than the left (it could have always been like this though, who knows). I still have slight pain ever now and again. Bench press doesnt hurt at all (1.5% Bodyweight) and neither does swimming (competitive level).

As for what I did - rest was a biggy, i had around 3 months break from the gym/ swimming. I don't have any instability in the joint (as far as I can tell) and I've accepted this is the best it's going to be (pretty close to 100% for most things). Every now and again it flares up (feels like inflammation within the SC joint) and there is some mild pain coming from the area (2/10 on pain scale). I haven't been able to isolate it to a particular movement, but sitting at a chair without chair arms triggers it sometimes (sounds odd I know).

I hope you have a quick recovery - I read a lot of scientific journals so if you want to discuss further I wouldn't mind!

I don't ever recall my shoulder becoming loose. What did your doctors say?

[AgnesBird]

Thank you for your answer.
Doctors don't associate my loose shoulder with the lump and pain around SC joint unfortunately. Although I can tell it wasn't like that before. I mean the shoulder was never as loose. I am 'clicking' person but this one is different. After reading plenty of articles I know that a failure in one of the joints which belongs to the whole shoulder group does impact the rest. So if you have problem in SC joint or AC joint it will impact the other one and generally it can impact the whole shoulder. Chiropractic says I should carry on with swimming, with my stabilising exercises but osteopath on the contrary says it's better to wait. He told me 2 weeks but I already had 3 weeks break and it did't help at all.
GP told me that I can't get any referral to a specialist since I don't need any operation Maybe I should for private visit with orthopedics?


I am amateur swimmer (up to 2.5km twice a week) and I can give it up for some time but it helps me with different problem and don't want to wait too long.
I additionally work quite hard physically at work so don't know if giving up exercises but carrying on with my physical work makes any sense.

[Eddzzz]

I figured out that going for MRIs and other diagnostic tests pretty pointless as they find it difficult to say for certain what happened. In my case if it had been discolated this wouldn't change the outcome as there is no treatment apart from wait and then buold up exercise again.

When i was researching i learned that any action that raises the hand above the height of the shoulder rotates the SC joint so I avoided those movements as much as possible to give the SC joint rest. Is your SC joint lower/higher/ more/ less prominent than the other? Maybe it's your AC effecting your SC. I think mine was SC dislocation as I had little/no issues with my AC joint/ shoulder.

If were going private/ NHS I'd try and see a SC/ AC joint specialist.

[AgnesBird]

Hi Eddzzz,

I spoke with few people who had prolotherapy treatment and it can really help to strengthen ligaments around SC joint but important is the technique this treatment is applied. It should be done using the microperforation technique under radiographic imaging. It's nice to join prolotherapy with PRL (platelet rich plasma). I already had PRL when I had Achilles tendon inflammation and it helped. I will try to get that treatment at some point.

For now I found really helpful video how to self massage subclavicle muscle which allegedly is overworked for most swimmers plus I overworked my arm by pulling so this muscle worked hard as well. It sounds crazy but before massage something skipped around my clavicle every time I shrugged my shoulders or tried to do circles with them. Now is all right. The same after whole night when I tried to raised from bed there was loud crack.

Because you are swimmer too if you want just have a look. Who knows maybe it will be helpful to you as well. Or maybe you know about this already. Nothing too lose (just a couple of minutes). Please find link to self-massage of subclavicle muscle video.

Self-myofascial release: Subclavius - YouTube

and the same massage but a bit advanced method.
Subclavius pain & trigger points - myofascial release - YouTube

Let me know what you think.
All the best Agnes