Sternoclavicular Joint Surgery

The Goal

Dr. Kevin Wall provides specialized, fellowship-trained surgical treatment for Sternoclavicular (SC) Joint disorders to restore function and relieve pain for patients in Richmond, VA, and the surrounding Central Virginia communities.The SC joint is the only bony connection between the arm and the rest of the body. Disorders here generally fall into two categories: Instability (where the collarbone pops out of place) or Arthritis (where the joint wears out). Because this joint sits directly on top of major blood vessels and the trachea, surgery here requires meticulous precision. The goal is to restore a stable, painless fulcrum for the shoulder girdle, allowing for safe movement and lifting.

This page is designed to educate you specifically about this procedure. Additional information that generally applies to most of Dr. Wall’s surgeries can be found on these pages:

• Pre-Operative Instructions

• Post-Operative Instructions

• Physical Therapy Protocols

The Procedures

1. SC Joint Stabilization (Ligament Reconstruction)

• Indication: Primarily for patients with chronic instability (recurrent or persistent subluxations or dislocations) or those with a traumatic posterior dislocation that requires reduction.

• The Technique: An open incision is made over the joint. Dr. Wall reconstructs the torn ligaments using a high-strength tendon allograft (donor tissue). The graft is passed through precise drill holes in both the sternum (breastbone) and the clavicle (collarbone) in a "figure-of-8" or similar configuration. This recreates the strong tether needed to keep the collarbone firmly anchored to the chest wall.

2. SC Resection with Meniscal Allograft Interposition

• Indication: Best for patients with painful SC joint osteoarthritis or post-traumatic arthritis where the cartilage is worn away.

• The Technique: Dr. Wall performs a "medial clavicle resection," carefully removing a small amount of bone from the end of the collarbone to eliminate the painful bone-on-bone contact.

• The Interposition: To prevent the remaining bone from becoming unstable or rubbing against the sternum, Dr. Wall inserts a meniscal allograft spacer into the gap. This acts as a durable biological buffer, maintaining the joint space and preventing the clavicle from drifting.

Post-Op Protocol

• Immobilization (Phase 1: 0–6 weeks): A sling is required at all times to protect the reconstruction or the interposition graft.

  • Strict Restriction: You must avoid reaching behind your back or extending the arm behind the body, as this puts direct stress on the SC joint.

  • Motion: Gentle elbow, wrist, and hand range of motion is encouraged.

• Start Formal PT: Professional physical therapy begins at Post-Op Week 6.

• Phase 2 (6–12 weeks): The sling is discontinued. Therapy focuses on progressive passive and active-assisted range of motion (PROM/AAROM). Scapular strengthening is introduced to help support the shoulder girdle.

• Phase 3 (12+ weeks): Progressive strengthening begins. A return to heavy lifting or contact sports is a gradual process, typically requiring 4 to 6 months to ensure the graft has fully incorporated.

When to Seek Care

You should schedule a consultation if:

• You have a visible, painful "lump" near your throat or the center of your chest.

• You experience a "choking" sensation or difficulty swallowing associated with shoulder movement (this can be a sign of a posterior dislocation and if your injury was recent you must present to a local hospital for evaluation).

• You have pain at the sternum that worsens when lying on your side or bringing your shoulders together.