Hello everyone,
I thought I'd chime in on this conversation because I have an interesting point of view. I'm a pre-med student from the U.S. who has done freestyle BMX for 7 years, powerlifting for 4 years, and mixed martial arts for a little over a year. I also happen to have unstable SC joints. The subluxation or clunking sensation began in 2007; it was painless and remained so until February of this year. It allowed me a high degree of function including boxing and benching around 300 pounds. In February, I felt a ripping sensation at the joint and it dislocated. From February to June it was extremely unstable, it would flip out from the sternum quite a bit. I had reviewed all of the literature available, and when I say all of it, I mean every piece of literature out there. I even went to the Mayo Clinic in Jacksonville for a consult and I e-mailed Dr.Rockwood, the authority on SC joint problems. I had read up on a treatment called prolotherapy, where they inject irritating solutions to try to trick the body into laying down more collagen. I was skeptical but figured, what the hell, the only thing I had to lose was money. I went to Dr.Stein in Plantation, a previous ortho surgeon with 30 years of experience and he administered prolotherapy to both SC joints using a 15% dextrose solution. Five weeks later they called and asked how the joints were doing. I told them nothing happened and that it was bullshit, obviously very annoyed. The next week, the right SC joint stopped coming out. There would be pain and some aberrant movement at the end ROM, but the gross abnormal movement had stopped. Two months later, the side that had dislocated and remained unstable for close to 5 months, was now more stable than the left side. I continued the treatment every 4-6 weeks, progressing from dextrose to sodium morrhuate. I felt disheartened because the left SC joint had not responded and I figured once again, this is bullshit. A week after my last treatment with sodium morrhuate, the left joint had a significant increase in stability. It was still able to subluxate and clunk, but it took more to get it to do it. The right joint continued to get tighter and more stable. Two weeks ago I received platelet rich plasma into both joints, as this is the strongest solution containing the most growth factors. I believe the technique used is of the utmost importance. A straight injection of PRP into the joint space is probably going to do jackshit. It's the combination of the needle itself causing trauma to the capsule, followed with the PRP adhering to these capsular defects that causes a global change in SC joint stability. I know this because I visited another prolotherapist who used a different technique and it was no where near as effective as the first doctor, who used a "peppering" technique with the needle and you could feel the needle scraping bone. My biggest question was why this happened to me. I am not a hypermobile person, I score a 2 on the Beighton hypermobility scale. My parents score 0 and 1. My sister scores around 4 or 5, probably due to her age and the inherent laxity found in females. I was referred to Sheila Klausner, the PT for the U.S. Olympic swim team. She found severe restrictions in ROM, forward flexion = 145*, internal rotation= 15-20*. The posterior GH capsule was incredibly tight. The restriction in normal movement caused a compensatory reaction from the SC joints, which then resulted in a loss of proprioception, basically my SC joints would be in the wrong position and I'd regard it as "normal" because I didn't know any other way. I am still treating this currently, but I have found prolotherapy to be effective. I really believe it depends on the skill level of the practicioner though. As we know, ligament healing takes a long time, up to a year for remodeling to complete itself. This treatment is all about time and moderation. I am also using herbal poultices applied nightly to the area. It sounds hokey, but check out PubMed for some interesting results of herbal plasters applied to healing MCLs in rats. The ligaments healed with a higher ultimate tensile strength and a larger diameter. The morphological structure of the herb treated ligaments resembled the sham ligaments moreso than the control group (transected MCL, no herb plaster).

Bottom line: At least attempt prolotherapy before commiting to a surgery and check all restriction at the GH joint. He may be compensating or he may just be hypermobile all over. What is his Beighton score? Surgery may or may not be the answer to his problem considering the atraumatic nature of the condition.