Sternoclavicular Hypomobility Interventions

This post is an individual project I am doing for Regis University’s fellowship in manual therapy program.

The movement of the shoulder requires movement at multiple joints of the shoulder complex1 This includes the sternoclavicular, acromioclavicular, scapulothoracic, and glenohumeral joints. There is also evidence that thoracic mechanics affect these shoulder movements as well.2 As a result, dysfunction in all these joints, including the sternoclavicular joint, can play a role in shoulder pain. The often overlooked sternoclavicular joint is the only bony attachment of the shoulder complex to the axial skeleton. Limited research suggests that manual therapy to this region can play a role in the rehabilitation of shoulder injuries.sis.2,3,4,5 These studies indicate physical therapy has a role in localized sternoclavicular joint pain as well as more distal pain referral patterns. Sternoclavicular hypomobility will be the focus of discussion here.

There is limited evidence to diagnose sternoclavicular hypomobility. In the clinical setting, some clinicians use the clavicular jump test to identify abnormal sternoclavicular joint mechanics. A recent dissertation looked at the reliability of this test demonstrating substantial to fair intrarater reliability.6 No known study has examined the validity this test. A study by Lawrence1 found the sternoclavicular joint to have decreased elevation in symptomatic patients compared to asymptomatic patients at 30 degrees of scaption, but no significant degree of difference at higher degrees of elevation. These impaired joint mechanics would be consistent with a jump found in a clavicular jump test. Again while no evidence supports the validity of this test, this knowledge of joint mechanics indicates this test may have benefit in the identification of abnormal sternoclavicular joint mechanics. Another clinical test would be manual assessment of joint mobility. No research currently exists examining this test.

Despite the limited evidence for testing sternoclavicular joint mobility, evidence exists for the treatment of impaired sternoclavicular joint mobility for upper extremity pain. One case study incorporated caudal sternoclavicular mobilizations in the successful rehabilitation of a full thickness rotator cuff tear.sis.3 A separate case study.utilized posterior sternoclavicular mobs in the successful treatment of thoracic outlet syndrome.4 These case studies indicate the promise of sternoclavicular joint mobilization in the management of upper extremity issues, but require further investigation in more rigorous studies. Expert opinion further supports the use of these techniques and indicates there may be a benefit of utilization of these techniques beyond the specifics of the previously reviewed cases.2

Another proposed treatment for sternoclavicular hypomobility is an upslip correction. A myofascial connection runs from the pelvis to medial clavicle. Treatment aimed at the pelvis influences this myofascial line altering sternoclavicular mobility. There is no available research directly supporting this intervention or mechanism, but this writer has seen clinical improvements in shoulder mobility utilizing this technique.    

A lack of research exists studying sternoclavicular hypomobility interventions. Case studies and expert opinion indicate these interventions may have a role in the treatment of shoulder dysfunction. These techniques should be considered for patients with shoulder pain. It is possible the clavicular jump test could be utilized to identify sternoclavicular hypomobility and to indicate the need for these interventions. Ultimately, future research in these areas is needed to better guide the treatment of sternoclavicular hypomobility.

References:

  1. Lawrence RL, Braman JP, Laprade RF, Ludewig PM. Comparison of 3-dimensional shoulder complex kinematics in individuals with and without shoulder pain, part 1: sternoclavicular, acromioclavicular, and scapulothoracic joints. J Orthop Sports Phys Ther. 2014;44(9):636-45, A1-8.
  2. Ludewig PM, Braman JP. Shoulder impingement: biomechanical considerations in rehabilitation. Man Ther. 2011;16(1):33-9.
  3. Mischke JJ, Emerson Kavchak AJ, Courtney CA. Effect of sternoclavicular joint mobilization on pain and function in a patient with massive supraspinatus tear. Physiother Theory Pract. 2016;32(2):153-8.
  4. Nichols D, Seiger C. Diagnosis and treatment of a patient with bilateral thoracic outlet syndrome secondary to anterior subluxation of bilateral sternoclavicular joints: a case report. Physiother Theory Pract. 2013;29(7):562-71.
  5. Edwin J, Ahmed S, Verma S, Tytherleigh-Strong G, Karuppaiah K, Sinha J. Swellings of the sternoclavicular joint: review of traumatic and non-traumatic pathologies. EFORT Open Reviews. 2018;3(8):471-484.
  6. Koc T. The Intra-rater Reliability of the Clavicular Jump Test (CJT). (2017). Seton Hall University Dissertations and Theses (ETDs). 2316. https://scholarship.shu.edu/dissertations/2316

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