What is Sternoclavicular Joint Reconstruction?
Sternoclavicular joint reconstruction is a surgical procedure employed to repair and restore full function of a damaged sternoclavicular joint.
The sternoclavicular (SC) joint is the joint between the breastbone (sternum) and the collar bone (clavicle). Injuries to this joint are called sternoclavicular joint injuries and can include stretching or tearing of the ligaments. It is usually caused due to severe trauma or a direct blow to the side of your body such as in motor vehicle accidents or contact sports.
The SC joint is one of the 4 joints that complete the shoulder and is the only joint that links the arm to the body. Like any other joints, the SC joint is covered by articular cartilage that helps the bones slide effortlessly along each other during arm and shoulder movement. Tough connective tissue known as ligaments surrounds the SC joint providing stability and strength.
Indications for Sternoclavicular Joint Reconstruction
Sternoclavicular joint reconstruction is indicated when conservative treatment fails to alleviate symptoms of sternoclavicular injury or if you have an irreducible or recurrent posterior instability or chronic and symptomatic anterior instability of the shoulder.
Preparation for Sternoclavicular Joint Reconstruction
Preoperative preparation for sternoclavicular joint reconstruction will involve the following steps:
- A thorough examination by your doctor to check for any medical issues that need to be addressed prior to surgery.
- Depending on your medical history, social history, and age, routine blood work and imaging may be ordered for safely conducting surgery.
- You will be asked if you have any allergies to medications, anaesthesia, or latex.
- You should inform your doctor of any medications, vitamins, or supplements that you may be taking.
- You should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for a week or two prior to surgery.
- You should refrain from alcohol or tobacco at least 24 hours prior to surgery.
- You should not consume any solids or liquids at least 8 hours prior to surgery.
- Arrange for someone to drive you home as you will not be able to drive yourself post surgery.
- A written consent will be obtained from you after the surgical procedure has been explained in detail.
Procedure for Sternoclavicular Joint Reconstruction
The surgery is performed under general anaesthesia. A transverse incision is made right below the medial end of the clavicle. A vertical incision is made in the capsule of the sternoclavicular joint and the status of the intra-articular disc is evaluated. The tendon of the sternal head of the sternocleidomastoid muscle is exposed and its quality and thickness are assessed before transfer. The tendon is separated from the muscle. A drill hole is made in the medial end of the clavicle. The hole is placed lateral to the attachment of the capsule. The tendon is passed through the capsule and then pulled through the drill-hole in the clavicle. The remaining tendon is passed through the capsule again before being returned to its site of insertion. The tendon is then pulled to reduce the joint and secured with sutures. The overlying tissues are closed in layers and the skin is closed with absorbable sutures.
Postoperative Care Instructions and Recovery
In general, postoperative care instructions and recovery after sternoclavicular joint reconstruction involves the following:
- You will be transferred to the recovery area to be monitored until you are awake from the anaesthesia.
- Your nurse will monitor your blood oxygen level and other vital signs as you recover.
- You will notice some pain and discomfort in the shoulder area. Medications will be provided for comfort.
- Apply ice packs on the shoulder to help reduce the swelling.
- Use a pillow under your shoulder while lying in bed for comfort.
- Medications will also be prescribed as needed for symptoms associated with anaesthesia, such as vomiting and nausea.
- Keep your surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
- Refrain from smoking as it can negatively affect the healing process.
- Eating a healthy diet rich in vitamin D is strongly advised to promote healing and a faster recovery.
- Refrain from strenuous activities, lifting heavy weights, and driving for the first 6 weeks. Gradual increase in activities over a period of time is recommended.
- An individualised physiotherapy protocol is designed to help strengthen shoulder muscles and optimise shoulder function.
- You will be able to return to your normal activities in a couple of months; however, return to sports may take 4 to 6 months.
- A follow-up appointment will be scheduled to monitor your progress.
Risks and Complications of Sternoclavicular Joint Reconstruction
As with any surgery, some of the potential complications of SC joint reconstruction may include:
- Stiffness or restricted movement
- Damage to adjacent soft tissue structures
- Anaesthetic complications
- Migration of hardware
- Recurrence of dislocation
- Sternoclavicular arthritis
- Non-cosmetic results
Benefits of Sternoclavicular Joint Reconstruction
Some of the benefits of SC joint reconstruction include:
- Provides a good anatomic reconstruction of the joint
- Reinforces the relationship between the sternum and clavicle and fully resolves any instability
- Minimal damage to proximal neurovascular structures
- Promotes tissue integration and maximises healing potential