Treatment of Sternoclavicular Joint Sprain Without Deformity
For an adult with an acute sternoclavicular joint sprain without dislocation, deformity, or fracture, conservative management with immobilization, ice therapy, and analgesics is the definitive treatment approach, as surgical intervention is reserved only for dislocations or chronic symptomatic instability. 1, 2
Initial Management (First 2 Weeks)
Immobilization and Pain Control:
- Apply a simple sling for comfort and support during the acute phase 3
- Provide adequate analgesia with simple analgesics such as paracetamol or NSAIDs unless contraindicated 4
- Apply ice therapy (ice and water mixture in a damp cloth or plastic bag) for 20 minutes, 3-4 times daily to reduce pain and swelling 5, 6
- Place a thin towel barrier between the ice and skin to prevent cold injury 5
Activity Modification:
- Avoid activities that cause pain or stress the joint 6
- Do not attempt to bear weight or perform lifting, pushing, or pulling movements with the affected arm 3
Clinical Pitfall: Ruling Out Dislocation
Critical Assessment Points:
- Examine for visible deformity or prominence of the medial clavicle, which would indicate dislocation rather than simple sprain 7, 8
- Assess for posterior dislocation warning signs: dyspnea, dysphagia, cyanosis, ipsilateral arm swelling, or paresthesias—these are medical emergencies requiring immediate reduction 7, 9
- If any uncertainty exists about joint stability or alignment, obtain CT imaging, as plain radiographs are often inadequate for evaluating the sternoclavicular joint 7, 9
Expected Clinical Course
Natural History:
- Anterior sternoclavicular joint sprains typically resolve with conservative management 1, 2
- Most patients tolerate persistent mild instability well with minimal functional impact 1
- The vast majority of sprains heal without long-term disability when treated conservatively 1, 8
Follow-Up and Persistent Symptoms
Reassessment at 2-4 Weeks:
- If pain or dysfunction persists beyond 2 weeks, obtain cross-sectional imaging (CT or MRI) to exclude occult fracture, physeal injury (in patients <23 years), or unrecognized dislocation 7, 8
- Consider referral to orthopedic surgery if symptoms persist beyond 4-6 weeks despite conservative management 8
Surgical Indications (Rare for Simple Sprains):
- Surgery is NOT indicated for simple sprains without dislocation 1, 2
- Operative intervention is reserved for: locked posterior dislocations, symptomatic chronic instability that fails conservative therapy, or persistent painful osteoarthritis 2, 8
- Patients should be counseled that even with surgery, there is a high risk of persistent instability, and operative intervention for anterior instability is mainly cosmetic in nature 1
Key Clinical Caveat
The distinction between sternoclavicular sprain and medial clavicular physeal fracture-separation can be difficult, particularly in younger patients (<23 years), and cross-sectional imaging is often required for accurate diagnosis 8. This distinction is critical because treatment options and outcomes differ significantly between these two entities 8.