Introduction

I have been working on this entry for quite some time and I hope it serves as a resource for patients who need guidance. Before beginning any physical exercise regimen, consult your doctor and make sure you are able to perform the exercises safely.

If you are reading this, I assume that you have suffered a dislocation/subluxation of your sternoclavicular joint. If you have not contacted a medical professional yet, I urge you to do so immediately. In addition, a posterior SCJ dislocation is a serious, potentially life-threatening injury that must be treated. To that end, this article will only discuss anterior SCJ dislocations.

The first step is reduction and immobilization. Your doctor will attempt to perform a closed reduction to place the medial end of the clavicle back in its proper position. In many cases, closed reduction will fail and the joint will dislocate/sublux again. This isn’t a huge concern because there are no vital structures in front your clavicle, only behind. Your shoulder girdle will be immobilized in either a sling or a figure of eight brace for 6-8 weeks. After this time period, there are three different possible scenarios: 1. The SCJ is healed, stable, and reduced, 2. The SCJ has healed in a subluxed position but is stable, 3. The SCJ has healed but remains unstable. The first two scenarios are ideal and rehabilitation can commence immediately. The third scenario depends on whether the residual instability is painful or not. If the SCJ is painful and unstable, then a decision must be made regarding treatment. Instability that remains after a lengthy period of immobilization may be resolved by surgery or regenerative injection therapy (prolotherapy, platelet rich plasma, mesenchymal stem cells). That is a decision that must be made by consulting with your doctor. In general, spontaneous SCJ dislocations have poor outcomes when treated surgically. Traumatic dislocations have good to excellent outcomes depending on the surgical technique.  The difference between spontaneous and traumatic is the following: spontaneous means your clavicle decided to randomly pop out and say hello, while traumatic means you dislocated it after falling or taking a hit. Spontaneous dislocations will usually be painless while traumatic dislocations are accompanied by tremendous pain. It’s my opinion that conservative treatment should always be attempted before more invasive procedures. I recommend the following order of treatment:

  1. Immobilization – let the connective tissue heal.
  2. Physical therapy - the SCJ may have healed/become stable or remain unstable. Either way, physical therapy will help retrain the muscles of the shoulder girdle and take some pressure off the SCJ. If the joint is unstable but painless, then no further treatment is needed unless you wish to play an overhead sport or a sport that puts a tremendous strain on the SCJ.
  3. Regenerative injection therapy – there are many names for this treatment: prolotherapy, sclerotherapy, etc. but the idea is to get your body to heal the connective tissue to a shorter length and stabilize the joint. This is a great option for people who wish to avoid the risks of surgery, but it is also takes a long time to achieve significant results.
  4. Surgery - many different techniques exist to stabilize the SCJ and some of them can be found in the ’Knowledge’ section of this website.

Rehabilitation

I will begin this section under the assumption that your SCJ has been treated and is currently pain free. It is not a replacement for physical therapy, but rather a mix of exercises that I have personally found to be useful. You should always consult your doctor and physical therapist before attempting any exercise or stretch that has not been prescribed.  

Stretches

The first step is to regain shoulder ROM. I will spare you the technical details and tell you which stretches to perform.

  • Pendulum stretch – Start with the pendulum stretch, it will relax the shoulder muscles and keep the capsule from becoming short.

    Pendulum Stretch

  • Sleeper stretch – The sleeper stretch will lengthen the external rotators and restore proper posterior gliding of the humerus on the glenoid fossa.

    Sleeper Stretch

  • Pec minor stretch on swiss ball – The pec minor becomes extremely short when your arm is placed in a sling or if you push far more than you pull during weight lifting.

    Pec Minor Stretch

  • Lat stretch on swiss ball – I like to perform the last stretch on a swiss ball because it lets you roll the ball around and create a variety of angles. To increase the stretching, tilt your pelvis away from the arm being stretched. You should feel a stretch go all the way down from your armpit to the bottom of your rib cage.

    Lat Stretch

  • Pull-up bar stretch – Only progress to the pull-up bar stretch once you feel comfortable with the lat stretch on the swiss ball. Do not actually hang from the bar. Stack some blocks up underneath it, grasp the bar and then slowly and gently lower yourself into a stretch by bending your knees and feel a stretch through your chest and lats. Keep the weight of your body supported by your legs.

    Pull-Up Stretch

  • Tricep stretch – This is a common stretch I’m sure you’ve done in the past. Perform it slowly and do not push the range of motion on this one. You should let off the stretch if you feel discomfort or if you feel the muscles locking up and spasming. At that point, you won’t be stretching the muscles, you’ll be stressing the ligaments of the SCJ instead.

    Tricep Stretch

  • Scalene stretch – Perform this while sitting down. This is a good stretch to help prevent thoracic outlet syndrome. It can become tight in SCJ dislocations due to the attachment points of the scalene muscles. If you feel numbness or tingling in your arms/fingers, etc. let off the stretch and tell your doctor.

    Scalene Stretch

  • Trap stretch – Do not apply too much pressure in this position. All you’re looking for is a nice, comfortable stretch. The traps can become chronically tight in the body’s effort to protect the SCJ by protracting and elevating the shoulder girdle, taking the stress off the anterior portion of the joint capsule.

    Trapezius Stretch

  • SCM stretch – Do not turn your head too much with this one. You should feel a light stretch in the front of your neck on one side.

    Sternocleidomastoid Stretch

  • Levator scapulae stretch – when this muscle is tight, the scapula will be elevated and pulled medially. Do not pull down hard on your head, apply very light pressure and discontinue/see your doctor if you feel numbness/tingling anywhere.

    Levator Scapulae Stretch

Scapular stabilization exercises

If the shoulder blades do not move properly, the SCJs will be exposed to abnormal forces. By stabilizing the scapulae, we establish a solid base for the shoulder girdle to rest upon the rib cage and it will allow the SCJs to function optimally.

The main thing we need to establish is proper scapular retraction and posterior tilting. After an anterior SCJ dislocation, the body will guard itself and resist scapular retraction because it places a lot of stress on the anterior SCJ capsule. We must train this movement pattern in order to tell our body that is safe to perform scapular retraction. If the shoulder girdle remains in a guarded, protracted position, it may lead to impingement and rotator cuff problems. Perform the following exercises with a light theraband or tubing.

  • Retraction plus external rotation – first retract your shoulder blades and then externally rotate your arms. With time, you will be able to retract as your externally rotate and it will become one fluid movement.

    Retraction w/ External Rotation

  • Horizontal pull-apart  -Keep the palms facing the ground and retract your shoulder blades as your arms come out to the side.

    Horizontal Pull-Apart

  • Diagonal pull-apart – Make sure to keep your thumb pointed up on the arm going up. This will prevent any possible shoulder impingement.

    Diagonal Pull-Apart

 

PNF movement patterns (sword),
Progress to lying WTYL.

Typical exercises to avoid

  1. Barbell bench press – If you’re a powerlifter, you knew this was going to be number one on the list. No one can tell you what to do with your body, but just be aware that in order to protect your shoulders you must maintain a fully retracted position on the bench. Combine this full retraction with hundreds of pounds going straight down. It will expose the SCJ ligaments to tremendous forces and you may injure yourself again. There are plenty of alternative discussed later.
  2. Barbell Back squats  – This is another exercise where your shoulder blades have to be held tightly in a retracted position. Combine that with thoracic extension to keep your chest up in the hole and you have a lot of forces acting on the SCJ in the anterior direction. There are plenty of other exercises to replace this with.
  3. Barbell Front squat – You’re resting the bar across your collarbone, avoiding this is common sense.
  4. Dumbbell flies – These place a huge amount of strain on the SCJs and can easily injure them. I would avoid this.
  5. Behind the neck anything – Not only is bringing the bar down behind your head bad for your rotator cuffs, it also places a strain on your SCJ. Be nice to your body and bring the bar down in front to your chest when performing shoulder presses and pullups.
  6. ***Shoulder presses – I put stars next to this one because it is conditional. If you lack the proper ROM needed to perform an overhead press correctly, then you should stay away from it because it will probably end up hurting you. On the other hand, if you have the proper ROM and it does not cause any discomfort, it is a great way to strengthen the shoulder girdle. A word of advice, don’t let the weight get too far behind you or it will place a lot of stress on the SCJ capsule that is already maximally taut.
  7. ***Dips – This is another conditional exercise. It exposes the SCJs to a lot of force and is notorious for injuring shoulders when not performed properly. Take it very slow on this one and ease into it. If it causes you pain in your sternum or SCJs, discontinue it.

A word of advice on the above exercises: If you’re a powerlifter and some of these lifts are your life, then ease back into them slowly and accept the risks you’re taking by performing them. NO ONE can tell you what to do with your body and you are the best judge of what is appropriate. If you are a bodybuilder or weight lifting enthusiast, please read on and consider the following replacement exercises. They will still induce muscular hypertrophy and some are quite challenging.

Alternative exercises

Replace barbell bench press with: Push-up variations including pushups with chains and weight vests. The scapulae are free to move while performing pushups and they are not maximally retracted for extended periods of time. They are excellent for promoting scapular stability and they are far safer than bench press exercises, which are usually improperly performed.

Replace barbell back/front squats with: Trap-bar deadlifts. They allow you to get into a squat-like position, but you hold onto the weight, allowing your shoulder blades to remain neutral and offers extra work to your upper back and grip.

Replace DB flies with: Partial ROM cable cross-over. I feel that these offer more control over the entire range of motion and they’re easier to bail out of if things go wrong. I wouldn’t take the ROM very far, just focus on a good contraction and then stretch the muscle out between sets.

More exercises

There are a ton of exercises out there to replace risky ones with and here is a small list.

Lower: Lunges, unilateral DB lunges, reverse lunges, elevated reverse lunges, leg press machines, leg curl machines, glute ham raise, sled dragging/pulling, all kinds of deadlift variations (without pain), one leg squats, goblet squats, KB swings, swiss ball leg curls, glute bridges, reverse hyperextensions, TKEs, etc.

Upper: Push ups (with bands, chains, weight vests, different angles, one leg, etc.), KB swings, unilateral DB bench press on swiss ball, pull-up variations, pulldowns, all kinds of curls and extensions (overhead extensions are a little risky, use common sense, if it hurts don’t do it), DB rows of all kinds, renegade rows, etc.

Core: Planks, glute bridges, side bridge, pallof press, woodchops, cable lifts, leg raises, etc.

There are a ton of exercises you can come up with in order to train around your weak spot. If you need some help brain storming, drop me a comment and we can come up with some more.

 

****This is still being edited.

 

 

 

102 Responses to “Sternoclavicular Dislocation and Subluxation Treatment”

  1. Great stuff, dude.
    Thanks a lot.

    • Moderator says:

      You’re welcome, Jason. I have a lot of other ideas that are on the way. Be on the lookout this week for an email from me.

  2. Cool.

    By the way, what’s your take on db lateral raises and bent-over db lateral raises?

    Here’s my experience on these exercises (beware of wall o’ text!):

    I’ve been doing both of them for about 4 months, now and managed to (more or less: still playing catch-up with my front delts) rebuild to my former delt size. Come to think of it, I’m pretty happy with the results, so far, since my shoulders have got even wider than they used to be, although not that ‘full’, yet (front delts).

    In the past, I didn’t to shoulder isolation work in this fashion and relied on heavy overhead pressing, instead. At this point, I’m pretty sure that doing heavy (up to 1.25 of my bw) behind-the-neck presses, full ROM with poor external shoulder ROM contributed a lot to my SCJ problems.

    Seeing how I had to forgo serious push exercises, you can see how my front delt development regressed.
    Recently, I’ve started experimenting with db front raises. Things didn’t pan out, at first: doing them with a db in each hand caused clicking and grinding in the SC and AC joints, regardless of grip type.
    But here’s the thing: clasping a db with both hands in a neutral-grip-ish way, keeping the elbows very slightly bent and not going over the horizontal works my front delts pretty well, without any discomfort.

    Last, but not least: delts seem to respond pretty well to using a high-rep approach. Here’s what has worked best for me, so far (since my SCJ injuries):
    * warming up (no brainer)

    * 8×8 db lateral raises (google ‘Gironda 8×8′ for more info on that)

    * doing 4-5 drop sets: I start with the heaviest load allowing me about 20 reps, immedtiately grab a slightly lighter set of dbs and repeat this until I can’t do more than about 10 reps

    I’m employing the same approach with lying/bent-over db lateral raises

    From a strength athlete / powerlifting perspective, this might seem asinine.

    I’ve never been a big fan of pre-fatigue techniques. But they certainly work.

    Are there better ways to progress in terms of strength and hypertrophy? Absolutely.
    Problem is: they’re usually not that compatible with SCJ and shoulder injuries in general.

    Thus, using a sub-optimal approach which still allows for progressing loading parameters will also get me there.

    On a different note: with all the rotator cuff and scapular stability work I’d been doing, I didn’t account for my atrophied deltoid muscles. I’m pretty sure they also play a role in stabilizing the shoulder girdle.

    I know that my days of heavy pressing are over. It’s all about being as functional as possible again. Having said that, I don’t mind the additional muscle ;)

    • Moderator says:

      Thank you Jason for the awesome post. I’d like to invite anyone who is reading this to share their advice and experiences dealing with SCJ injuries. We can all learn a lot from each other.

    • Here’s another tidbit I found to be quite useful: whenever I’m performing shoulder or back exercises, I tuck my chin in a bit to take stress of the sternocleidomastoid muscle.

      Not doing that led to straining the SCJ due to the pull on the sternocleidomastoid muscle, especially with horizontal rowing exercises.

      Apart from that:
      is there any way to maximize isolation of the subclavius muscle? I know it’s involved with horizontal pressing, but: how can I modify horizontal pressing exercises to maximize subclavius involvement while minimizing pec participation? The point is: I don’t want to have to use super high loads to force the subclavius to join the pecs.

  3. I recently came across your site when searching for information about a subluxing sternoclavicular joint. Despite all of the information available on the Internet, there is very little information about this injury out there and what I did find up until wasn’t very promising. I am approaching 30 and played college football, so I have an idea of what caused the injury in the first place. About 10 years ago I had surgery on my shoulder to repair a torn ligament that bothered me since high school. During rehab, one of the therapists noticed that my sc joint would pop, or sublux, whenever I raised my hand over my head. Her and the other therapists were mortified at the situation and couldn’t believe I wasn’t in severe pain from it. It was interesting being paraded around the office like a medical oddity. Honestly, I had no idea how long my SC joint had been subluxing or if it was related to the surgery. They set me up with an orthopedic surgeon and he had never seen the problem before and gave the great advice of don’t lift your arms up. How would I reach up in a cabinet? You’re 6’5”, you probably only need a small step stool he replied. So I went to second Dr. and basically the same response and he mentioned arthritis and how it could dislocate eventually. The third fitted me for a figure eight brace. I took a full 16 months off of weight lifting and wore this brace religiously, but the injury still remained. I started to get back into lifting weights, just trying to keep it out of my head. There really isn’t much pain associated with it, just an annoying and cringe worth popping. I have avoided swimming over the past 10 years and try to play as little basketball as possible. I started to research again and the only option appeared to be live with it and hope nothing happens, or risky surgery. Not being a fan of a surgery few doctors have ever heard of, let alone performed, I was all set to live with it till I came across your site and story. I am open to trying pretty much anything to be able to swim, lift weights, and play basketball. No more living and dealing with it, I want to be able to lift my arms over my head at will without the subluxation. Being able to military press 300lbs is not a priority, just the overhead movement. Would you mind me either posting some questions through here or sending you an email? I didn’t see a specific contact on your site, but you have mine and would be welcome to contact me.

    • Moderator says:

      If it’s acceptable to you, I’d like to keep our conversation in this public forum so others in your position can reap the benefits of reading it. If you don’t feel comfortable with that, please email me at smcaleer@knights.ucf.edu and I will be glad to discuss matters in private.

  4. Thanks for your reply Scott. I have no problem posting this for others to hopefully benefit from, as I know all too well how hard information about this injury is to come by. Ideally, I would like to keep you and everyone else updated as much as possible on any course of action that I take. Honestly, I have no idea where to start. I know for me just physical therapy and trying to tighten the area did not work. For over two years I went though with the exercise three days a week with no success. The figure eight brace also did nothing to stabilize the joint alone. I noticed where you underwent prolotherapy and it appears to be the most effective course of action. Currently I have been trying to do some research on prolotherapy to at least get a basic understanding of how it works and more about the joint itself so I can sound education when I have a conversation with the doctor. What course of action would you recommend I take? I am hesitant to go to another orthopedic and bring the idea up to them. Based on past experiences all I am expecting is a sorry there is nothing I can do and stay away from that witchcraft medicine. I live up north in Maryland, so it wouldn’t be easy for me to come to Florida to visit your doctor. When you had your joint injected where there any special restrictions on lifting or activities for the 8 weeks? My job would be able to accommodate limited activities and I want to do everything the way that gives me the best chance of permanently stabilizing my joint.

    • Moderator says:

      I did a quick search and there was one doctor in MD who caught my eye due to her previous involvement in academic medicine. http://www.drgheen.com/about.html . I’m not sure how close that is to you, but I would occasionally take the 4 hour trip from Orlando to Ft. Lauderdale to get treatment and it was easy to make a day-trip out of it.

      I wouldn’t expect your SCJ to stop subluxing with any kind of exercises due to its passive stabilization. It’s almost a miracle that it stays in place at all. There are muscles pulling on it from every angle and yet it relies almost exclusively on ligaments to keep it stable. It is not like the glenohumeral joint, which relies on the dynamic stabilization of the rotator cuff blended into a relatively loose capsule. The subclavius muscle is the only muscle that pulls it down into the manubrial notch and it is often ineffective at doing so once the ligaments have been stretched.

      You said you tore your shoulder ligaments while playing football, so I’m guessing it was a common dislocation in the anterior/inferior direction. They fix this by tightening the shoulder capsule. A lot of the time, the shoulder becomes over tight and you have to work with the capsule to get it to the right length again. The glenohumeral joint will rotate approximately 120 degrees in forward flexion, and the last 60 degrees comes from posterior rotation of the shoulder blade (scapula). If the GH joint, which is the humerus connecting to the shoulder socket (glenoid fossa), is too tight, where do you think your body will try to get the extra range of motion from? It will go upstream to the SCJ. The extra forces put on the capsule from the posterior rotation of the clavicle is enough to actually lever it out of its little notch on the manubrium. In other words: It basically winds up till the ligaments are tight and then that extra stretch to make up for your lack of movement at the GH joint is enough to stretch it. This is my theory given the information presented.

      No competent surgeon who has reviewed the literature would ever touch you with a scalpel, given your lack of symptoms. The research done by Dr. Rockwood, Dr. Groh, Dr. Odor, and Dr. Wirth would suggest that you need little more than reassurance that your condition is benign and will not progress to become debilitating. Can anyone guarantee that? No, of course not, but for the majority of people with your symptoms, it is merely a nuisance. You have likely dwelled on the matter due to the therapists over-exagerrating the condition and making you self-conscious about it. I do not mean to downplay your condition, but rather inform you that your condition is rather self-limiting and you should not be afraid of anything concerning that joint.

      You know from personal experience that physical therapy does not work. I know that no surgeon will touch you in the absence of extreme pain and disability. That leaves us with the option of prolotherapy. If you decided to take this route, you must realize that it is a slow process and requires great patience on your part. It is in my opinion, the medical equivalent of bodybuilding. You don’t go to the gym one day and expect to wake up the next day bigger and stronger. No, it takes months of consistent work to appreciate any difference in strength/size. If you decided to get it injected, you will have to wait a full 6 weeks to really see if it did anything and then repeat the process many times.

      Considering that you are not a strength athlete, activity restriction should not be a problem for you. If your work requires overhead lifting and activity that may be a different story. After you have been treated, merely keep the SCJ stable with your other hand while reaching up to get things out of cabinets or while stretching that arm overhead. The point is to keep the arm moving, but not produce the subluxation or prevent it from occurring with your other hand while still moving the arm through its full range of motion. This will keep the muscles from becoming tight and adhered to each other.

      There’s another point that I want to get across here that I feel is very, very important. Sometimes, people can become obsessed with their diagnosis and think about all of the things that they can’t do or what they perceive they can’t do. I powerlifted and fought with SCJs that were probably more unstable than yours and I was fine for a long time, but I really did take it too far and abused myself. That’s just to show you that you can really do a lot with this condition. There have been professional tennis players with it! To that end, just think of the treatments as your monthly check up. It’s like going to the orthodontist to get braces tightened. Not a big deal. You go to the office, get the treatment, shell out some money, and then kick back and wait for your body to do its own thing. After several months, you will suddenly realize that your joint didn’t pop out on a movement that previously made it sublux and you will know that what you’re doing is effective. Will it completely cure the subluxations? I can’t answer that, but I can speak for myself and some of the other people who have had it done and tell you that it’s a lot better than what you start with.

      Keep me updated on your progress and let me know if you have any questions.

  5. Hi Scott, just came across your website today after continuos searching for information about sc joint dislocations. I’ve read a couple of your blogs and you seem to know a lot about what to do for this injury (more than what any doctor has told me). In october 2010 i was playing a rugby match and i got stuck in between two big props which literally squished my rib cage together making a loud crack causing my sc joint to pop out of place. After the match i noticed that my sc was raised a bit out of place. The following week i could move and lift my arm but it was still painful. So i saw my club physiotherapist and he tried doing easy exercise with me like pushups with knees on the ground but while doing this exercise i heard a loud pop which made me stop immediately. Later that night i noticed that my sc joint was out much further than the other one. Very worried about this i rang up an orthopedic surgeon (fortunately a family friend & did previous surgery on my elbow)and saw him and all he said to me was there “is nothing to do but give it time” and “an mri is pointless to get as it will already show what we know is just a ligament tear” he then injected me with local anesthetic and cortisone which did absolutely nothing. So i listened gave it time saw around 4 different physio’s who unfortunately did nothing either to make it any better. Frustrated with it i rang up my surgeon again and he referred me onto to someone how knows more about this injury then he did. By doing this the next doctor arranged to get me a dextrose injection which i was given on the 25th of February (which from what your saying i think is prolotherapy?)after this i met the doctor and he said that “i don’t need any more of these injections, should give it four weeks rest from the date of injection and go back to light weight training”. I gave the amount of rest told (and a week and a bit more) and went back expecting miracles but unfortunately i could still feel the strain on the joint. It felt a bit better than before but still protruding out of my chest a good bit.
    At present i have laid off upper body weight training for about 5 weeks now. As nothing seemed to be working i decided to get acupuncture which has helped loosen the muscles around the joint and began to take up jogging to help with blood flow to the area. This has helped a bit but unfortunately no miracles here either..
    I’m so frustrated with this as if i sit still for a period of time without moving my arm and then decided to push myself to get up i hear a loud crack and feel pain in the sc joint, trap and shoulder region. I feel like it is never going to properly repair and i won’t be able play rugby again let alone be able to dip my bodyweight!
    I have torn and had repaired my ACL and split my elbow bone in two which i have had surgically repaired to, but i feel this injury is so much worse as their is very little i can do to make it better and the lack of proper guidance doesn’t help.
    What can you recommend for me to do??
    Should i get more of these dextrose injections?
    Should i go back and start doing light resistance on this joint?
    Any guidance would be great.
    Thank you and looking forward to your reply.

    • Moderator says:

      Your case is interesting because it shows another side of SCJ injury. Up until now, almost all of the posts have come from people suffering from atraumatic disorders of the SCJ.

      This is a great opportunity to explain the difference between surgical outcomes for both groups.

      First, lets address the injury itself. High speed impact during rugby = initial dislocation. Roughly a week later you tried some push-ups but the capsule had not healed yet. Your shoulder blades retracted, the medial end of the clavicle translated anterior and more of the capsule tore, resulting in an even larger displacement. The first ortho you went to was right on the money. A MRI would be useless if the medial end of your clavicle is sticking out…I think the problem is pretty clear. The cracking is probably coming from a torn intra-articular disc. The therapy you received was prolotherapy and there are stronger solutions to use aside from dextrose.

      Now on to the important question you’re probably asking: Will prolotherapy fix this or will I need surgery? That depends on your definition of successful treatment. In a high speed collision sport like rugby, I think you’d need the strongest reconstruction possible. I do not play rugby and I stopped powerlifting entirely after the event because it was not productive anymore. Prolotherapy treatments have restored my normal abilities to participate in sports. I can throw a ball, throw a punch, etc., but I do not think it would hold up to a perfectly placed rugby tackle. If I were you, I would look into a reconstruction surgery for your SCJ, because there have been other cases like yours where it has worked out great. The difference between you and I is the etiology of our SCJ dislocations. Mine was atraumatic and yours was traumatic. I have a disposition to dislocation just by how my joints are formed and the robustness of the ligaments (or apparent lack thereof). Your dislocation was a traumatic accident. What this means is that if a surgeon reconstructed mine, they would probably get loose again and dislocate without any trauma just because I’m built that way. If you get yours reconstructed you have a better chance at making a full recovery. Dr. Castropil in Sao Paulo, Brazil published a paper on a Judo player who dislocated his on a throw gone wrong. He resected (took out) the disc and reconstructed the joint capsule with a semitendinosus tendon from the hamstring (perhaps what your new ACL is made of). The Judo player recovered with a lot of PT and is back to Judo.

      It has been a while since your initial injury and most people would probably be as recovered as they’re going to be at this point. The strength of the ligament will continue to increase over the course of the year, but I doubt you are that patient…I wouldn’t be.

      The decision is up to you. Just know that for traumatic SCJ dislocations, the results of surgery are generally better and there have been case reports of patients returning to contact sport (Judo) and heavy labor jobs.

      I think you should contact a good surgeon. There are some in Vail, CO at the Steadman-Hawkins clinic that do awesome work and also in TX and TN. If you need help finding some contact info on an author that has successfully repaired SCJs, let me know and I will help you with your search. Also, contact me via email, smcaleer@knights.ucf.edu and I will send you some research to read. You should be educated to the utmost before making any decision.

      • Thanks a million for your fast reply, it has been the clearest information to date for me and has really got me thinking now about considering surgery. I have been looking at some research literature on it myself but its very hard to come by, and a lot of what i read has said not to (as well as my doctors). Unfortunately i forgot to mention in the post on your blog that I’m from Ireland so i gotta do some research of my own of what doctors do this type of surgery here (and from what i already know there isn’t a lot!).

        I just have two questions regarding what you wrote back to me:

        You mentioned “people would probably be as recovered as they’re going to be at this point. The strength of the ligament will continue to increase over the course of the year”. Do you reckon that overtime the ligament could settle and stabilize the joint or from what i’ve done so far the road could be leading to surgery?

        You also mentioned that you have a “disposition to dislocation just by how my joints are formed and the robustness of the ligaments”. I also must mention that i have been told by physiotherapists over time that i have over flexible joint and have resulted in some of my other injures (ACL, elbow). Which i presume had an impact on my sc. But is this similar to what you have? which i fear might effect the surgical option.

        I just did the Beighton modification and got a score of 3 out of the 5 exercises (it measures up to 9 so i don’t know where i am on the scale).

        Getting your email there with the research will give me loads to read now on the process available. Good luck in your finals I’m too doing them so my goal is to look into this dreaded injury fully once I’m finished them.

  6. Thanks so much for your fast response, again. I’m looking at the Dr. you recommended an also any places near Philadelphia or the surrounding areas. Currently I’ compiling a list of questions to ask so I am ready for a consultation.

    What you said about the physical therapy not working is exactly what I have experienced over the past years and really didn’t surprise me. For some reason I still held on to some hope that it might help, but it didn’t. My shoulder surgery was for a torn labrum. Originally the Dr. thought it was just a lose joint and I went to therapy, but that did nothing for it and it still hurt with repetitive overhead movements like throwing. Years of pitching, quarterbacking, swimming, and volleyball must have taken their toll on my shoulder. After the surgery is when the therapists recognized the subluxation. You are correct that they made me freak out over it. Anytime someone parades you around because of something they haven’t encountered in 25 years can be rather alarming. You informing me that it is more of a mental issue is music to my ears. It is rather annoying, but my worries were of it progressing into something worse.

    Although I would not consider myself a powerlifter anymore, I still routinely lift weights and have no problem benching over 350lbs, which used to surprise and scare me that my joint could even hold up. I don’t really lift heavy much now and try to stick to sets of 10 now and very seldom go above 275lbs. Usually anything around there or above causes one side to sublux on every rep. Ten pops in a row can be annoying to me and a discomforting sound/sight to anyone who might be spotting me. I think it was quite amazing the abuse the joint too. Add in a few hours of basketball every week. The only thing I really gave up was overhead movement such as throwing, volleyball spikes, and swimming long distances.

    With the therapy, I have subluxations in both joints. Can they treat both sides at once? You mentioned that I would take 6 weeks off after the injection and try to keep it from subluxing, I might try the old figure 8 brace to help here again, then I would go back for another treatment. Any idea of how many treatments would be needed total? I am trying to estimate how long I will need to monitor this so I can plan out what time would be best. Did the prolotherapy completely cure your subluxations? Do you think they could come back after time? Your site is amazing and I can’t thank you enough.

    • Moderator says:

      Hi Nick,

      I’m sorry I didn’t get back to you sooner. I had to finish up my final exam week.

      They can and should treat both sides at the same time. That is how mine were treated. I can’t tell you how many treatments you’d need because there are too many variable to take into account. I’d say the average is probably around 4 to 6 though, depending on the extent of instability and your ability to heal. The prolotherapy healed them to a large extent. I still feel a little bit when hitting pads or doing something towards the end ranges of shoulder motion, but they continue to feel better over time. I definitely think they would come back if I went back to powerlifting without mobility work, which is the mistake I made for a long time. With proper stretching, lifting heavy in the future could be a possibility. I think my problem is a little more structural than most. Since I was a child, the ends of my clavicle have protruded really far. There may be a propensity towards subluxation at that joint.

      Keep me posted on your progress.

  7. I work as a sports physiotherapist in Australia and have dealt with this condition both personally and with patients.

    Something that is worth note is the role of the upper trapezius as a scapular (and indeed entire shoulder girdle) stabiliser. Search in google scholar “anatomy and actions of the trapeizus muscle – Bogduk”

    The stretching and strengthening is simply not enough with this condition. You need to change the the onset timing, relative contribution and strength of key muscles to shoulder movement – namely the upper trapezius and serratus anterior must function to upwardly rotate and elevate the shoulder. There should be exercises on the web for this. And a quick point before stretching your upper trap – check that your symptomatic shoulder isn’t already sitting more depressed. If it is, then you shouldn’t be stretching your upper trap, you should be re-training and shortening it. If it was tight it wouldn’t be sitting lower than your other shoulder.

    Scott, I’m not sure which shoulder you have injured but if it is your right I wouldn’t bother doing your upper trap stretch.

    The pec minor stretch is good in theory, however you will often just stretch out the anterior SCJ further.

    • Moderator says:

      Awesome post Peter, thank you for contributing.

      I’ve read the following article: Click Here
      It cites the article you told me to search and reinforces your view on the muscle’s stabilizing effects. Another interesting point to make is that I noticed my shoulder girdle become more elevated over time as my SCJs became increasingly stable. The reason I included the stretch is that many people complain about the chronic tightness in their trapezius muscles, whether it’s beneficial or not. The pec minor stretch will, without a doubt, stretch the anterior SCJ capsule if the joint is still lax. If the joint is stable, then a light pec minor stretch can be applied as long as pain is not felt in the sternoclavicular region.

  8. Hi…I just wanted to say that I recently discovered your valuable website, and exercises. I my subluxation occurred about 5 months ago (spontaneous, non-traumatic). I have a similar background to many on this site (was a butterfly swimmer), and now am a competitive tennis player. I initially stopped using two hands on my backhand because that involved the injured side, but have recently discovered that it is throwing the ball overhead to serve with my left arm that hurts. In the last month there has finally been some progress (in terms of lack of swelling/pain). In the studies I read on your site some seem to advocate getting the joint back in place; in others this seems not critical.

    Have people had success with a chiropractor working on this problem? Mine tried once, and it was rather painful, I’m not sure it’s worth it or possible to really address the issue.

    • Moderator says:

      Hi Steve,
      With an atraumatic spontaneous subluxation, the joint should naturally reduce itself as you bring your arm down from an overhead position. If it rests slightly anterior to the other SCJ, that is just a sign that the ligaments have stretched slightly, allowing the medial end to translate a little bit farther than normal. Your chiropractor can do all the posterior glides he wants, it’s not going to go back and if by some small miracle it does, it won’t stay reduced for long. Worse yet, if he pushes too far in the posterior direction he can cause harm to the posterior capsule, which is the primary restraint to both posterior AND anterior translation.

      Dr. Rockwood actually published an article about atraumatic spontaneous subluxations and one of the patients in the case study was a professional tennis player. He received no treatment other than reassurance and skillful neglect and he did just fine. In short, don’t waste your money on a chiropractor to push on your joint. The manubrial notch is shallow and only a very small portion of the medial clavicle even interacts with it. The ligaments are the primary restraint to all aberrant movement. You could try to find a prolotherapist to tighten it up with some injections, however this is a lengthy process and the effectiveness may be reduced by your tennis playing. If it’s not hurting you too much, just work on strengthening the scapular stabilizers, work on perfect form, take some anti-inflammatory supplements like omega-3 EFAs and turmeric, and maybe get a topical joint spray supplement like Joint-force by Ergopharm. I heard good things about that topical spray I just listed, you can look at it here .

  9. William says:

    Good Day all….

    I have had some experience with this injury…

    I was involved in a motorcycle accident, and suffered a dislocated SCJ, two fractured ribs, and a broken hand….

    after surgery to insert a plate to keep the SCJ in position, it took a while to heal, but then caused arthritic growth of the joint….

    I then had a SCJ excision done, to remove the joint…I think its called synovectomy?

    now the joint seems somewhat unstable, but I’m back in training like before…
    My SCM has been used to fill the gap where the joint was taken out, and now seems somewhat shorter? every time i turn my head it pulls excessively??

    also, a few questions:
    1. I used to play rugby…would that be out of
    the question now?
    2. What stretches do I need to do to get my SCM
    to relax?
    3. would it be considered a dangerous situation
    to have your SCJ removed? Is the medial end
    of the clavicle not close to some major blood
    vessels?

    • Moderator says:

      Hi William,

      You have some loaded questions there.
      The procedure you underwent is this one I believe Click Here
      The medial end of the clavicle is resected (cut off) and then an interpositional arthroplasty is performed. They basically take the sternal head of the muscle and move it to where the medial end of the clavicle used to be. The reason they do this is to potentially prevent the regeneration of the medical clavicle, which has been reported in multiple cases not utilizing the interpositional arthroplasty technique.

      1. You would have to ask your surgeon what he thinks about it. If the medial end feels unstable, it probably wouldn’t be a good idea to sustain a rugby tackle. In fact, a lot of the guys who post here messed their SCJ up playing rugby in the first place.

      2. There are a variety of stretches that you can perform, just google, “SCM stretch.” You may also benefit from seeing a massage therapist. There may be trigger points or adhesions within the muscle preventing it from relaxing.

      3. It is a risky surgery and the risk increases with bony overgrowth due to post-traumatic arthritis.

      In short, you will have to speak with your surgeon. If he believes the joint is stable enough to play on, then go ahead but be aware that rugby poses a high risk to the SCJ regardless of previous injuries to the joint.

  10. William says:

    Good Day

    Thanks so much for the reply, much appreciated….

    1. The surgeon said that the medial end of the
    clavicle will settle against the SCM,
    however,pushing my shoulder forward causes
    the medial end to protrude over the place on
    the Sternum where it used to attach? in some
    cases I’ve seen that the “figureof 8″ method
    is used to attach the SCJ to the top of the
    first rib? My first rib was dislocated as
    well tho?

    2. I used to go to physio for a while, and that
    seemed to help? Maybe I should do that again
    then?

    3. I actually have some issues related to the AC
    Joint on the same shoulder, and might have to
    get a AC Joint Decompression soon.

    4. are there any surgical procedures to have the
    first rib reset? as the dislocation has caused
    the rib to move backwards?and now there is an
    indentation?

    • Moderator says:

      1. If the procedure matches the one I posted above, they actually stitch the tendon into the medullary canal of the clavicle. This means some of the tendon is stitched into a little tunnel in your collarbone. You are missing part of the medial end of the clavicle and as such, it will have a different interaction with the manubrium than a normal clavicle. The figure of eight reconstruction preserves the medial end of the clavicle, however it may or may not resect the intra-articular disc. The figure of eight is between the medial end of the clavicle and the manubrium. The first rib does not play a role in that reconstruction. Other reconstructions may utilize a loop of tendon around the clavicle and first rib; this may be what you’re thinking about. The first rib dislocation would heal along with the SCJ after the surgery you had to immobilize it.

      2. If it helped and you can afford it, then it’s a great idea.

      3. That is unfortunate, however very common. It is not a very extensive procedure.

      4. I’m not sure I understand your comment. You state that the first rib is indented? Unless you are having thoracic outlet syndrome, I would leave the first rib alone. If you feel that all of your pain is coming from the first rib, you should bring it up with your surgeon when addressing your other concerns.

  11. Hi,
    I’m liking the website, it’s good that resources and people suffering with this can come together as most doctors are pretty dumbstruck when I show them. My subluxation/dislocation happened spotaneously and although it is uncomfortable and it hindering me working out in the gym, it is not painful. Although I do worry that it will become painful and I will lose the use of my shoulder altogether.

    As a matter of course, would you recommend doing the stretches every day? Also I have booked some physiotherapy sessions, what should I tell them I need to do as I worry they won’t have seen this injury before and it will be a total waste of time/money.

    • Moderator says:

      I doubt that your SCJ laxity will progress to a lifestyle altering condition in the future. The literature supports the previous statement. I would tend to gravitate away from powerlifting on them though.

      I would not recommend doing the stretches every day. That routine is for those with healed SCJs without a lot of appreciable laxity. In your case, you should simply keep the mobility you have and not push into the end range of motion or into pain. Your physiotherapy session may not be a complete waste. There are plenty of bright physiotherapists that I’m sure will be glad to help you come up with some innovative solutions for your individual condition. At worst, you waste a little bit of money and perhaps learn a little bit in the process.

      If it’s not causing you pain, I would recommend you ignore it and keep living life to the fullest without reservation or fear of what could happen.

      • Thanks for the response,
        I went to the physio and he has seen that my shoulders are a bit out of balance and my chest is pulling my shoulders forward a bit. So just starting excercises to correct this, hopefully this will strengthen my shoudlers and hold them in a more neutral position, it’s got me thinking about my posture more as well (or lack of!).

        In terms of gym workouts, would it be better to stick to the exercises you have listed to avoid the potential for aggravating the injury, after having a bit of time off I would like to get into a good routine for the second half of the year.

        • Moderator says:

          I would stay away from chest exercises that use an exaggerated range of motion and exercises that force you to remain in a position of scapular retraction for the duration of the set (squats and bench press specifically). Training scapular retraction is important when stabilizing the shoulder girdle, but I don’t like the idea of maintaining an end-range position under load. Touch and go is my rule of thumb for scapular retraction. As your SCJs stabilize you can spend more time in that end range of motion, but don’t push it before you’re ready. When performing rehab exercises, I like to use cables or bands. They offer constant resistance throughout the range of motion, unlike dumbbells whose momentum can be dangerous, You can still train your chest, but I would focus on pulling exercises for the first few months in order to balance things out a bit and get your shoulders back where they should be. Your chest won’t go anywhere and you’ll have healthier shoulders to work with when you add some chest exercises back into your routine.

          I’m actually in the process of finalizing my own routine and I will post it when I go through it. Another frequent poster is also interested in documenting his training and he has some great advice for those wishing to bodybuild.

          If you have any specific exercises in question, just let me know and I’ll give my thoughts. Good luck!

  12. Hi
    When I was 17 I suffered a 3rd degree posterior traumatic dislocation of my sterno-clavicular joint through playing rugby. Up until this point I had remained injury free and enjoyed a healthy lifestyle with kayaking being one of my other hobbies.
    It is fair to say that this was the single most painful thing that I have ever experienced. I spent 3 days in hospital with people prodding and poking at me with no real clue at first what was actually wrong with me and then once they knew they were not sure what to do. I was told that it was unlikely that I would play rugby again or go kayaking for a long time. The decision was made to give me surgery. Fortunately for me my anaesthetist gave me an injection of muscle relaxant around my scj after I was put under general anaesthetic and this actually caused a partial reduction and the surgeons were then able to manipulate my joint by clamping my collar bone and repositioning it this way. I am now pleased to say that I have made a full recovery and I was back playing rugby 4 months after the injury occurred and have done for the past 3 years with only brief periods of mild discomfort at times and a slightly bigger looking joint. I have not been held back by this injury.
    I came across this website because I realised that I actually knew very little about what I had done and I wanted to find out more and I think this website is fantastic. I wish that I could of read something like this when I had the injury because I was truly terrified and had no idea what was going on. So this is just to tell people really that this injury doesn’t mean that you will never fully recover.
    I know this may not be helpful to many of the people looking here who have a reoccurring problem or dislocated there scj in other ways where surgery doesn’t have great outcomes. But I just really wish that someone had been there to reassure me when I was going through this so that’s what I’m doing and I hope this helps anyone who reads it.

    • Hi Chris,
      Your post was awesome! Thank you for sharing your experience and giving hope to those who are currently suffering from SCJ problems. This brings up an important point for the readers of this site; you are responsible for living your life and making the decisions that dictate its course. Don’t let anyone tell you what you can or can’t do.

      “It is not the critic who counts: not the man who points out how the strong man stumbles or where the doer of deeds could have done better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood, who strives valiantly, who errs and comes up short again and again, because there is no effort without error or shortcoming, but who knows the great enthusiasms, the great devotions, who spends himself for a worthy cause; who, at the best, knows, in the end, the triumph of high achievement, and who, at the worst, if he fails, at least he fails while daring greatly, so that his place shall never be with those cold and timid souls who knew neither victory nor defeat.” – Theodore Roosevelt

  13. Greetings.
    I have a right-side sternoclavicular dislocation as well. I never noticed it until about five days ago, I’m estimating that I have had it for about 4-5 years now. There was only slight pains in my sternum and shoulder which I thought was just from doing tons of jiu-jitsu. I thought it was from trauma, but because it is still in place and that just the tendon is torn it is kind of complicated. I first noticed it because I have recently began getting chest pains in my lungs and heart. I believe that because the shoulder has nothing supporting it, it has just been laying on my lungs and has been putting a lot of excess pressure on my lungs and heart.

    So now I am in the business of trying to get this fixed. I bought a figure 8 brace and it is still coming in the mail. My hope is that if i can stabilize my clavicle for about 6 weeks then the tendon will heal..even though it could have been torn for like 5 years. I’m not really sure what else to do at this point.

    • Hi Jimmy,

      I doubt the figure of eight brace will do anything at this point since you’ve had it for 5 years.

      You really need to see a doctor concerning your chest pain. It sounds rather insidious and is not congruent with the pain referral patterns usually noted with SCJ problems. If you are cleared from any major problems, it does sound similar to costochondritis which is very common in jiujitsu athletes especially if they find themselves on the receiving end of the knee-on-belly position. Bottom line: get it checked out by a doctor.

  14. Greetings,
    I am 17 years old and since 2 months from now I noticed that I have a (painless) left-side anterior SCJ subluxation(I am right-handed myself). However, I believe I’ve had it for 1 year already, since I started working out 1 year ago. I believe it’s possibly due to wrong work-out methods, since I haven’t experienced any accidents that could be the cause. I’ve seen my doctor – to my surprise she didn’t know what it was and simply told me to treat it with physiotherapy. They gave me some exercises to strengthen my upper back and shoulder muscles. They also told me to prevent movements that will cause my collarbone to sublux. However, I find it inevitable to prevent these movements, since it occurs already with the simplest movements, e.g. when I change my clothes or when I try to reach for something higher than my shoulder. So now I’m afraid that it won’t heal properly since my collarbone subluxes every day due to these movements which I find very hard to control. I also haven’t had a figure 8 brace, would this help?
    Also, my given exercises were mainly to strengthen my muscles, not to stretch certain areas. Should I ask for stretch exercises or perform your stretch exercises, they seem quiet relevant and focused on the collarbone.
    And my last question, will this ever heal completely? I sincerely hope so.

    Thanks in advance.

    • Moderator says:

      Hi Bashar,

      Thank you for your comment. If it has been one year since the onset of SCJ subluxation, then I’m inclined to believe the ligaments are in a permanent state of laxity. Considering this, I doubt the figure of eight brace would do anything to help your current condition; it is used to immobilize the shoulder girdle after acute trauma to allow the torn ligaments to heal at the proper length. Your physiotherapist obviously does not know the anatomy of the joint well enough to understand the implications of preventing movements that will cause your collarbone to sublux. The SCJ is stabilized exclusively by ligaments and the subclavius muscle that runs underneath the clavicle and pulls the medial end down into the manubrial notch. The powerful pectoral muscles of the chest and sternocleidomastoid muscles of the neck pull on the joint and will cause subluxation if ligamentous restraint is disrupted. Do NOT immobilize your arm or you will run the risk of developing adhesive capsulitis (frozen shoulder) over time, which I assure you is much more painful and debilitating than your current asymptomatic SCJ subluxation. Instead, I would like you to move the affected arm through a complete range of motion while manually stabilizing the SCJ. Literally put your hand over the SCJ and apply just enough pressure to prevent it from popping in and out. Do not apply excessive pressure; you do not want to place excessive stress on the posterior capsule of the SCJ (the ligaments behind the joint). I would not perform the stretches I listed on a separate blog post because they are for completely healed, stable SCJs. Instead, work on your mobility exercises to keep everything moving properly. Continue to perform the physiotherapy exercises you were shown for your shoulders and upper back. They will not cause the subluxation to cease however they will help prevent damage to your shoulders over the long run, due to the lack of stability at the SCJ. If prolotherapy is an option where you live, it would prove to be a boon. Just make sure that your prolotherapist is familiar with the anatomy of the SCJ and the proximity of the great vessels that lie just behind the joint. To answer your last question: the frequency of subluxation may decrease over time or it may persist. In either case, it should not hinder you in any way and I would suggest staying as active as possible. If prolotherapy is an option, it may help stabilize the SCJ enough to prevent subluxation.

  15. I think you are spot on with the costochondritis. Thank you.

  16. Thank you for the respsonse,
    when you say that those exercises you listed in the blog post are for ”completely healed, stable SCJs” I wonder, how exactly did those people become completely healed and stable?
    I have been doing my physiotherapy exercises for 1 and a half month now, but I still don’t feel any progress. Sure, my muscles in my upper back, shoulders and chest are somewhat more stable and slightly stronger, yet my clavicular joint keeps subluxating. So I’m planning to see my GP soon again and hope that she will direct me to an orthopedist. I also haven’t seen a place for prolotherapy, so I don’t really know what else to do now.
    Thank you for your information.

    • Moderator says:

      In those who suffer a traumatic SCJ dislocation, the amount of damage to the tissues will be enough to initiate a humoral response and the body will know that the joint was injured. This will spark a repair process with new collagen being laid down in the form of scar tissue in an attempt to repair the damage. An atraumatic subluxation does not offer the same humoral response. There is no major trauma but the effects of long periods of micro-trauma are clearly expressed in the form of lax ligaments. Consider the following comparison:

      You’re driving down the highway and suddenly you hit a large scrap of metal and your tire blows out. You immediately know that your tire is flat because there was some definitive trauma. You better repair that tire. Compare that to a tiny screw placed in the tire. The tire loses air over a very long period of time. Probably long enough that you don’t even realize that the tire is losing air. You walk out to your car one day and it suddenly dawns on you, “Why is that tire almost flat compared to the others?”

      The same process takes place in your body. If a ligament is exposed to one definitive traumatic event, it causes a lot of damage and the body knows that something needs to be repaired. If there are very small supra-maximal loads placed on a ligament over time, it will deform and become longer than normal, allowing aberrant motion to take place at that joint, but there is no signal given to the body that something is wrong because the changes happened gradually over time.

      In some cases the healing that occurs after a traumatic dislocation is enough to stabilize the joint and no further treatment is necessary. Often the amount of healing is insufficient and either surgery or prolotherapy is needed to restore stability to the joint. If the initial subluxation was atraumatic, then the only hope for stability is through either surgery or prolotherapy since there is no initial healing response by your body. In many cases, the joint may continue to be unstable but not cause any pain or loss of mobility which means no further treatment is needed unless desired by the patient. I specifically address the exercises to people with completely stable SCJs because I do not want to be held responsible for someone with a grossly unstable SCJ performing a stretch beyond his/her capability and ripping the SCJ apart completely.

      Your physical therapy exercises will not stabilize the SCJ to any large extent. You will require either prolotherapy or some kind of surgical stabilization since the SCJ depends on ligamentous support alone. If the subluxation does not cause you pain, I would not worry about it at all. I was more active/stronger than a large percentage of the population with SCJs (both sides) that were grossly unstable so do not let it hold you back in your fitness endeavors. There will be an exercises section created in the near future to help you in this regard. Let me know if you have any further questions.

  17. Hello,

    I’m a 33 yr old who suffered an anterior SCJ playing rugby back in 2009. After resting the injury for 3 months, I was cleared by my sports physician to play rugby again. After a 1 1/2 of playing I retired in 2010.

    After the summer of 2011 I was training for a 1/2 marathon and didn’t lift much, and this november I started doing crossfit with a lot of the exercises modified. Since then I feel like I have reaggravated the injury. On a scale of 1-10, the discomfort is at a 2-3, but when I lift on my upper body it’s about a 4-6. To make matters worse, I am in an enlistment process with the air national guard, and eventhough I was cleared with making my injury public to my recruiter and military docs, I don’t want this to prevent me from enlisting. I know that I can get strong again. I have been doing cardio, core, and a lot of lower body work. Any advice??

    Thanks guys!

    • Hi Rebecca,

      I see a common thread through a lot of the posts on this site…it’s full of rugby players!

      At this point, you’re probably just feeling the effects of a little bit of degeneration in the joint; nothing that can’t be cleared up with a little rest, omega-3 EFA, and possibly a mild anti-inflammatory. As far as your training is concerned, the exercises commonly used in Crossfit are not the best for those with previous/current SCJ injury. I would stay away from Kipping pullups and focus on normal pullups with a full range of motion. I cringe when I watch videos of Kipping pullups being performed. They require a huge deceleration force and have the potential to seriously injure you. Another exercise I would perform in moderation is dips. I don’t care if they’re dips on parallel bars or rings, they both place a huge stress on the SCJs. If you want to perform them, then go conservative on the range of motion and do not ever relax in the bottom position. I would not allow my upper arm to go past parallel with the floor. Another area of caution should be the Olympic lifts. A lot of people get sloppy with their form at the end of a set and Crossfit is notorious for poor form. Always be in control of the weight and do not let it passively pull your shoulder girdle down after a high pull or power shrug. Work on using your entire body to decelerate the bar.

      Let me know if there is a specific movement that really irritates the SCJ and I will come up with some kind of suitable alternative.

  18. I am very impressed with the information on the site and I have a question of my own. I am an 18 year old natural bodybuilder who lifts religiously. My pelvis is slightly unaligned and I have a left rib flare. The other week I got sick and it seemed like my sternocleidomastoid got very tight. I took a week to rest and on back day during the deload I did rows, deadlifts, lat pulldown, etc. The day before was shoulders with reverse flies and behind the neck press, etc. The day after the back day I was doing a lat spread pose and my SC joint was subluxing. If I pull my left clavicle back and down it subluxes. It does not do it if I do overhead movements. No pain or anything but wanted to know what you think it is and what you recommend. Thanks.

    • Moderator says:

      Hi Nick,
      It sounds like your SCM actually pulled the medial end of the clavicle up. There have been reports of this happening. I believe one of them was due to labored inhalation in a man suffering from end stage liver disease. What worries me is that you say it subluxes when you pull backwards on it. That is a very dangerous kind of subluxation due to the proximity of large blood vessels. Pain associated with overhead movement does not necessarily have to be associated with this kind of subluxation but it may wear away at the vessels over time or cause a complete posterior dislocation due to mild trauma. I recommend you see an orthopedic surgeon as soon as possible to rule out posterior subluxation.

  19. Tim Davis says:

    Wow! Great info. Thanx for reassuring me. I am 63 yrs old and am recovering from a serious mountain bike crash. Traumatic anterior dislocation. It’s been 9 weeks. Ribs are healing finally. Was very concerned about future activity. The joint remains loose and pops abit, but no pain, and motion continues to improve. Are there any complications in the future I should be aware of? Thanx again for all these posts.

    • Moderator says:

      Hi Tim,

      The only future complication you will encounter might be osteoarthritis, but you can cross that bridge when/if you get there. If anything, you might just have a joint that is a little noisier than before. Keep working on that range of motion but don’t overstress the healing tissues. Take turmeric and omega-3 essential fatty acids to decrease inflammation and I think you’ll be just fine.

  20. Tim Davis says:

    Thanx. I appreciate your time and help.

  21. First off I want to say the information on this page is great! I am still dealing with an SC joint problem and am getting frustrated on what action to take with it.
    Heres my story. I am a strongman who has been dealing with an SC joint problem since September of 2011. I first injured it while praticing car deadlifts for an upcoming competition. I finished my last rep and as I held the weight at the top I felt my left shoulder drop slightly and it sounded like a back cracking. My joint was very stiff after that and movement was painful. I had little ROM due to the surrounding musculature being tight. I can still feel the medial end of my clavicle with palpation and it is slightly noticable in the mirror if you look for it. I don’t have any popping sound with it like alot of people on this site have reported. I honestly don’t think I would have any problems with it if I wasn’t a strength athlete, I just dont think I could ever give it up.
    I let the joint heal for a few months and slowly started working back up. I got to the point where I was working back up heavy in deadlifts and actually hit a PR, but injured the joint again. The 2nd time wasn’t as traumatic as the first time, but it was painful enough that I knew I had to take a few months off any movement that aggrevated it. So here I am today with a competition this Saturday (The first one since August 2011 because of this damn injury) and wondering what action to take afterward? I worked up to contest weight with the farmers walk and I think I tweaked it again. I know this due to the fact that my left scapula gets very tight if I overdue it accompanied by some pain of the SC joint with palpation.
    I have a few questions and would appreciate your opinion.
    1. Since I can feel the medial end of my clavicle is still displaced, will I have to get the joint back to the correct position to be able to function in a sport like Strongman without it affecting me? The doctors I have talked to say that it probably won’t go back to its original position, but it just seems to me that I will just keep constantly injuring it and tweaking it if its not in the correct position.

    2. Would you recommend looking into reconstructive surgery to fix the problem, prolotherapy, or just more rest? I dont want to give up the sport. (I don’t think I could anyway I love it too much)

    Another thing I would like to note about exercises. I do agree with staying away from the bench, dips, squatting with a straight bar, etc. However I have found that using a cambered bar causes no pain at the SC joint when squatting. I have also worked up to 800lbs on the yoke and still had no pain, but I had discomfort with 225lbs on a straight bar. I think it has to do with the positioning of your hands.
    Other events I can do are carrying events, log pressing, stones, and a few others. The ones that cause pain are axle clean and pressing, deadlifting, and farmers carries.

    Any help or suggestions you have would be much appreciated.

    • Moderator says:

      Hi Dustin,

      Thank you for the compliment on the site; I’m glad you find it useful! To answer your first question: No, the SCJ does not need to be in the correct anatomical position for it to be clinically stable. The scar tissue that forms will hold it in place, albeit slightly more anterior than it was before, but considering your mechanism of injury, it should not matter much. When I imagine your injury, I see enormous weight pulling down on the shoulder girdle depressing it past the ligamentous restraints offered by the SCJ capsule. I never thought I would tell this to someone who deadlifts cars but I think you need to strengthen your traps. The medial end of the clavicle is pressed into the manubrial notch when you carry a weight. It’s basically the pivot point for a strut (your clavicle). When the lateral end of the clavicle (near your shoulder) is depressed by a huge load, it will place stress on the entire SCJ capsule as well as the costoclavicular ligament. It would be so much easier if you were a powerlifter but instead you go out there and deadlift super heavy weights for reps, which means you’re going to fatigue and those last reps are going to look ugly as hell. With this in mind, I recommend training endurance. Grab a working set weight and do static holds with it in the deadlift position for as long as you can. You can gauge the amount of shoulder girdle depression either by visual inspection using a mirror or better yet, by using kinesio-tape. You can run a strip from the tip of the shoulder up over the traps to the base of the neck with very little stretch. This way, when the shoulder is pulled down you can feel the tape stretch the skin and you get a physical cue to maintain proper scapular posture.

      My answer to the second question is a resounding NO to surgery and a maybe to prolotherapy. I would try more conservative measures first such as the static hold training and rest, before suggesting prolotherapy. It is a much less invasive option compared to surgery but it still carries inherent risks and costs a significant amount of money depending on where you go. The only time I would even consider surgery for the SCJ is if you have advanced osteoarthritis causing painful bone spurs/cysts and severely affecting your quality of life. Even then, a success for a normal person would be getting rid of the pain while a success for you would be lifting 400 pound atlas stones and lifting cars. You must realize that an excellent surgical outcome does not include continued participation in extreme sports.

      I would have guessed that using either a cambered bar or safety squat bar would reduce the discomfort since your not forced into an end ROM when using either of those bars. The yoke also uses a much wider grip compared to back squats, which may also contribute to the lack of pain. You probably have some low level, chronic inflammation going on at that joint due to the multiple injuries you have sustained in a short period of time. I would suggest running a short cycle of NSAIDs and seeing if it clears up some of the pain. Please let me know if you have any other questions. Good luck in your competition!

  22. Thanks for the information and recommendations. I will add in some more trap work and static holds into my routine. I think this should help tremendously. I have two more questions if you don’t mind.

    1. How long does this injury take to fully heal? (given proper rehab is applied and I don’t do anything stupid with it)

    2. When it fully heals will I be able to get back into more variations of pressing such as benching, inclines, axle pressing, some of your “typical exercises to avoid”, etc?

    • Moderator says:

      1. It should take approximately 3 months to noticeably heal although the remodeling process takes over a year and the ligament will not be as strong as before.

      2. You will indeed be able to return to these exercises, however caution is advised and I urge you to take baby steps in your progression to heavy weights. Give the connective tissue ample time to recover and adjust to the new weight. Due to the avascular nature of ligaments, they take a long time to remodel and grow stronger compared to muscle. I do not recommend using an exaggerated range of motion. A 2-board bench press will suit you well.

      Good luck and let me know if you have any further questions.

  23. Hello. I first experienced symptoms about 1 month ago, which was just a slight clicking in my sterno-clavicular joint, on the right side & a hard bump on my sternum. At first I just left it, but one day after returning home from the gym (climbing gym, I do not lift weights, but climb 4 days a week) I was kind of being stupid & did that ab flex where you put your hands on your head, anyway I felt a severe pain in my sternum that quickly subsided & within 2 days back to no pain at all. After that the clicking & grating got a lot worse, I went to see my doctor who was not concerned at all, but still sent me for x-rays on my chest, which came back normal. I have no pain, only discomfort from the grating, & one other troubling symptom, which is a feeling of something pressing on my throat slightly, also my voice sounds different when I sing & when I yell my chest near my clavicle hurts. The choking feeling was bothering me so I went to the ER tonight just even mostly for another opinion on it, & because of how irratating it feels. The doctor told me almost verbatim “There is no possible injury to your sc joint that could cause dysphagia or that feeling in your throat”. I even said “what about a posterior sc dislocation”, & his reply was that it’s no where near my throat? Very discouraging as I’ve read on litrerally tens of sites that a posterior sc dislocation can cause those symptoms. I was curious if you know of any thing else that might mimic these symptoms aside from a posterior sc dislocation? I would totally return to climbing care free if I didn’t have the choking feeling. Thanks in advance

    • Moderator says:

      Hi Eric,

      The mechanism of injury does not sound like a posterior SCJ subluxation and I believe you noted a bump on the anterior (front) side of your sternum, suggesting you may have a slight anterior subluxation or perhaps some damage done to the intra-articular disc which would cause the popping and grating you’re experiencing. A normal x-ray will not show anything. When I was injured you could grab behind my clavicle and pull it out from the sternum close to 2 cm and the x-ray still came up normal. Damage done to the disc can be visualized with an MRI and a CT scan would identify any degree of subluxation although it is probably unnecessary to expose you to that kind of radiation for a proper diagnosis. The dysphagia and voice changes are troubling signs regardless of what the ER doctor said. Most doctors have never encountered an SCJ injury and are unfamiliar with the related symptoms. I would find a shoulder specialist in your area and consult him for peace of mind and to rule out and possibility of posterior subluxation. Once ruled out, I would run a cycle of NSAIDs to kill the acute inflammation and see how you feel. If it is comfortable enough to exercise on, I would spend some time working on scapular stabilization exercises and invest in a good fish oil/joint supplement to suppress any chronic inflammation. The choking feeling may also be associated with muscle spasms along the front of your neck. When I am done exercising my SCM muscle twitches like crazy. Let me know how everything turns out and best of luck to you.

  24. (I sent a couple of messages last week or so, and they got swiped somehow, so
    I’ll recap my journey a bit and see if you can help me)

    Hi, I am a 45 and a pretty active mom, but I don’t play rugby or lift weight too
    much. :-)
    My injury is a month old- right anterior mildish subluxation.
    It probably occured atraumatically because of imbalance or weak girdle
    support-have had dull pain in right trap and scapula for long time
    previous–perhaps from stress of being a mom or years of tennis in my youth.
    Anyhow after overusing my sc joint one weekend–shooting 3-point shots, doing
    elliptical, etc, not to mention always seeming to wake in AM on my right side
    feeling my clavicle impinged, May 25, I awoke with the classic bump on right
    SCJ.
    There was pain, but I still had good ROM, just couldn’t lift anything from down
    low in front of me or press my arm toward my ear when raising overhead. I
    couldn’t be certain, but seemed as if the problem was anterior, but not superior
    or inferior laxity.
    Ironically, all my scapula and trap pain…gone when SCJ injured..

    My MRI that I had to request from my orthopedic dr. showed effusion at the
    manubrium – probable contusion and a possible tear on inferior side of capsule.
    So…sounds like a little trauma afterall ( I had been pushing around on it a
    good bit for days and got it hurting, swollen)
    Also, I thought the inferior side of the capsule wasn’t really covered too well
    by ligament? I was still not clear on HOW hurt the ligament was.

    Meanwhile I’ve done a good amount of scapulae stabilization exercises and
    finally got a figure 8 brace two days ago.
    My phys therapist used iontothetapy and sonography over the last few days to
    help me get inflammation down and improve circulation.
    And then this afternoon, I reached high in my closet for some things, and wow!
    the clavicle seemed to pop back into place for the 1st time. There was no “bump”
    at the scj.
    I hope it stays, but i do know the stats.
    I just feel like it’s a miracle it went into place. I felt pressure in my HCJ? &
    a dull ache down my scapula right afterward which has stayed with me all evening
    since.
    Ive been staying taped with Kinesio.

    My therapist had suggested last week that her partner– 30 years experience,
    could slowly manipulate and encourage the bone back bit by bit over time. What
    do you think of that idea…in case I need it?
    I love the prolotheraly idea to help stabilize also.
    It just seems one ought to try all thats possible while the healing is going on.
    I am happy to stay in figure 8 and strengthen my back, shoulders forever.:)

    I’ve gotten so much info from your site, btw. It’s helped me to point my doctor
    in right directions.
    Thank you so much for how you are willing to hear all of our cases and answer
    them so personally and caringly. I know we all wish our physicians could be
    better at handling these SCJ situations, but I guess there’s nothing like
    experience to motivate and educate.
    I will gladly accept any advice or insights you have!
    Thanks so much!
    God bless,
    Lisa

    • Moderator says:

      Hi Lisa,

      It seems you have a solid grasp on the mechanism of injury so I will not delve into a discussion of that topic. There are cases where the medial end of the clavicle subluxes and it requires manipulation to reduce the joint. I believe your overhead reaching caused a self-manipulation resulting in the reduction. Since you stated that the medial end of the clavicle is now sitting properly with no noticeable bump, I believe it would not be wise to further manipulate it. I doubt that the posterior capsule is too tight and the only thing manipulation would do at this point is stress the posterior capsule, which is the primary restraint to anterior translation of the joint. I would advise you to continue the kinesio-taping routine if you feel like it’s helping the joint stay reduced and do not partake in strenuous exercises or movements that place a lot of stress on the joint for at least 5 weeks. It takes quite some time for ligaments to remodel and this is assuming the inferior aspect of the capsule is actually torn due to trauma. To answer the question about the ligamentous support on the inferior side of the joint: the inferior aspect of the joint capsule is continuous with the anterior portion and it is quite robust although not to the same extent as the posterior capsule which must be thicker/stronger to protect the delicate vessels that lie behind the manubrium. I think that prolotherapy would be a great idea for improving stability but it takes quite some time to achieve results. You could attempt to keep the joint reduced, work through PT, and then if it’s still giving you trouble, run a short course of anti-inflammatory medication to kill chronic inflammation. Do not mix the two together though. Try one therapy at a time and judge the results that they give you. If it subluxes again but becomes asymptomatic, then by all means, let it rest without further provocation. Let me know if you have any further questions and thank you for the praise. I run this website for everyone to benefit from and I was in your exact place 3 years ago so I know what you’re feeling and I want to do as much as I can to help. I wish you the very best and I hope this helped.

      • Thank you so much!
        I trust you are going to be a orthopedic dr. some day?!

        The joint has stayed “bump free” so to speak, but it does seem like the curved collar bone on my right side is just slightly forward of the left…It could just be that the medial end is seated down in its place, but the capsule itself is just raised a little. If so, its probably because of the posterior weakness that you referred to above. Interestingly the medial end only seems to try pushing over again during sleep–though I’m sleeping solely on back.
        I was very glad to hear that it take 3 months to remodel the ligaments, because that gives me hope of being pretty normal again.
        I realize that I will likely always have to protect the SCJ and keep on working on the shoulder girdle health/strength.

        My right shoulder is slightly rotated forward still, and I am constantly readjusting it the way my PT showed me–shrugging shoulders up to ears, flipping palms outward, and then “putting the shoulders back on the shelf” of the rib cage. It does feel like I have to consciously force the tissue surrounding my shoulder joint to stay put in right position every day. I’m not sure if this is because of the subluxation or if the subluxation is because of it?? Maybe its a GH or ACJ issue??
        Ive noticed a lot of people’s shoulders look the same way I am describing even though they don’t have our sc problem, but in my case it seems to have made quite a difference in shoulder health.
        Have you heard of people remedying this type of problem through consistent PT? I have been doing safe shoulder exercises with therabands for 6 weeks–since injury. (I had very few ROM problems after my subluxation)
        You’ve been very encouraging; thanks so much!
        Lisa

  25. Hi, just looking for some opinions, and help would be great….
    I was playing ball hockey and a guy hit me into the boards and I felt a pop and pain, i couldnt lift my left arm very high. Anyway so I went to this sports Chiro, he said it was just a sprain, and he did some treatments which only really was him massaging the muscles around that area. So 3 weeks later i have full range of motion and almost full strength back, but still have a bump and my trap on the side of the injury get sore faster than the other side. So its probably been 2 months or more now cuz the Chiro said it should go away and I believed him, so just wonder what i should do? Ive been play hockey 3 times a week and working, even working out (push ups chin ups) and not a problem but something is still wrong.

    • Moderator says:

      I don’t think you have a problem you should be too concerned with. You probably stretched the anterior capsule enough to displace the medial end of the clavicle and make it protrude slightly. If it is stable and pain free with full range of motion then by all means proceed with whatever you’re doing but try to guard it from further harm for a few months while the ligaments heal and contract. Your trapezius muscle should relax over time as your body learns to stop guarding that side of the shoulder girdle. If it does not then I would consult a physical therapist for an evaluation and proceed with manual therapy and possibly some kinesio tape techniques aimed at relaxing the trapezius muscles.

  26. Hey Scott,
    I have been doing crossfit for about 6 months. One day I was working on ring dips and was pushing out of the bottom of the dip and felt a sharp pain across my upper left chest area. I kept up my crossfit workouts, ended up doing my first muscle up while injured and put up over 200 lbs doing clean and jerk. The soreness continued and still had a hard lump on the clavicle. I kept seeking medical advice after 4 months I finally seen a sports medicine doctor who told me to stop lifting upper body and sent me to a PT. I have been seeing a PT for about a month and a half the hard lump has gotten softer but while sleeping it gets tight again. Just wondering if you had any suggestions for me, I would greatly appreciate it.

    Thanks

    Josh

    • Hi Josh,
      Without any kind of real diagnosis, I can’t add much to this discussion. Is the lump due to an anterior subluxation of the SCJ? Is it a tear of the clavicular portion of the pectoralis muscle?

  27. Hey I just got a SC joint injury last month and had a few questions!

    Its only been about 6 weeks, but my range of motion seems to be good and the joint seems stable. I can do pushups and basically work it out with no pain. The area around it is still kinda tender and sore though sometimes and can be irritating.

    My main concern is the bump I have though on the joint. Its only visible when I flex my chest muscle. What is this bump and will it go away?

    Also you mentioned it takes more than a month to heal, so I am still healing? Should i be doing pushups and stuff?

    Thanks!

    • The bump is probably just the medial end of your clavicle protruding slightly. It becomes more pronounced with the clavicular head of the pectoralis muscle pulling on it. It will probably not go away completely but it is more of an aesthetic concern than a functional one. I would lay off the exercises for a couple months but if it seems stable, then do whatever you can without pain or subluxation and you should be good to go!

  28. This is great info. I need to contact the moderator asap. I injured myself trying to stab a snake with a shovel and hit a brick. I am an avid low handicapped golfer and cannot play. Please help. I am seeing a PT but have questions on surgery.
    Is it possible to talk on the phone?

  29. It has been a year that I have had a posterior dislocated sternoclavicular joint, but I still go through severe pain every day and still do physio therapy. How do I know when I’m ready to start lifting weights again?

    • Hi Luca,
      You must first obtain your doctor’s approval before attempting to lift weights. If the joint is still unstable, it would not be a wise decision. Talk to your doctor, explore your options, and then make an educated decision. If you still have pain every day and it is interfering with activities of daily living, you may want to discuss surgical options with your doctor.

  30. Most informative website I have found on this topic. About a month ago I was doing a 310 bench pyramid, on the third to last set, I felt a pop in my chest while pushing the barbell up (did not bounce the bar). My body weight is 175 lbs. I now have a very obvious protrusion on the right side of my chest where the clavicle meets the sternum. I assume this the medial end of the clavicle. The pain was quite disturbing at the time and ended my workout for the day. The next day I went to my GP and had an x-ray taken. According to the tech and the doctor the clavicle did not look dislocated or fractured. I have no popping or clicking, just a large bump. The doctor said to take a couple weeks off and then ease back into weight lifting. Being me, I took one week off and then tested where I was at. Barbell bench is very painful and weak, it is somewhat tolerable with a rolled up towel on my chest (variation of board technique), but still very weak.. The 2nd week back at gym, Dumbbell Bench is doable (80lb dumbbells 4 sets of 10) without any noticeable pain. Seated barbell military press has a little pain, but standing dumbbell military press has no pain. Deadlift, squats, back/pulling exercises, curls seem to be around where they should be. Dips are painful and have been avoided as well as lateral raises. I have switched from a 5 day split routine (pre injury) to a 3 day full body routine (post injury) to take some stress off of my joints. Recovery days following weight lifting I have a fair amount of pain upon waking. I have pain down the right side of my neck through the top of my shoulder, as well as, behind my right shoulder blade. I am very stiff in the above areas, as well as my chest, in mornings. I am 32 years old and my biggest concern is returning to normal, as well as, chest strength/development down the road. I have an appointment with an orthopedist this week, hopefully some good news will be reported. Any advice would be appreciated
    Thanks

    • Moderator says:

      I have commented on other cases very similar to yours in other threads. Give the ligaments time to heal and give the joints a rest. Follow your doctor’s instructions and do not jump back into heavy weights too quickly. Focus on floor presses for now to limit the range of motion.

  31. I suffered a subluxation of the SC Joint approximately 1 month ago, have been mildly working out since then, trying not to aggravate the injury. Finally went to an orthopedist today, who said I had a 2nd degree sprain. The doc said to take six weeks off and come back for a check up. I hate to take that much time off. Any recommendations on exercises I can do that will not aggravate the injury. Also, has anyone had any experience with Cissus and ligament repair/healing.

    • Moderator says:

      Cissus will decrease the inflammation but do nothing to accelerate ligament healing. It is, in my opinion, the flavor of the week in bodybuilding joint supplements. For the next month focus on doing movements that do not cause any pain. Let the pain be your guide. I would refrain from any kind of heavy upper body work, especially bench press and military press. Do not retract your shoulder blades so far that you feel a stretch on the joint. You will be able to retract them all the way once it heals, but for now try to keep your shoulder girdle in neutral to avoid stretching the ligaments.

  32. Hey. A great article! I didn’t think there was a website like this.
    I wanted to ask. I have been to doctor and he told me there is no point in doing a surgery if you can like this, because surgery can often even worsen situation. Haven’t prescribed anything. So I don’t know what to do.
    I do stretches, bodyweight exercises with ease but right now I feel some kind of discomfort in that area. So should I do all these stretches you recommend? And when performing push ups- should I retract shoulders? Because then my joint pops out. Thanks again.

    • Moderator says:

      You should not do the stretches if your joint is still unstable and popping out. You should attempt to decrease the frequency of subluxation as much as possible if the ligaments are still healing. If you suffer from atraumatic subluxations, they will continue and should not hinder you from sports activities, but you must be mindful of stretching past your limits. You may want to stretch while manually stabilizing the medial end of your clavicle. In other words, hold your SCJ together while you stretch your chest and lats. You can avoid subluxing the joint while doing pushups by placing a small box under your chest to limit the range of motion. You should only lower yourself to the point where your elbows are level with your back (90 degree bend in elbow). Do not allow your elbows to go past the plane of your back.

      • Thanks for answer.
        But what should I do if i don’t know if it’s traumatic or atraumatic subluxion? Also I ahve my joint popped almost all the time and it doesn’t hurt any. Should I worry or should I folow my doc’s advise: ” If you can live like this – live”?
        Thanks again.
        P.S.: Pushing the joint in is a bit painful and is very hard, so should I struggle to push it in or just stretch as it is?

  33. Hi there –
    after two years of chronic pain and misdiagnosis, it turns out I have a sternoclavicular subluxation (partial dislocation of the joint).
    I don’t know what kind of doctor in my area can treat this. A sports medicine doctor? Osteopath? Chiropractor? Who should I go see? Any recommendation would be helpful.
    Thanks!

  34. Thanks.
    But what should I do if I don’t know if joint sublexed from traumatic or atraumatic event? It is almost always popped out, doesn’t hurt, but when I try to push it in I fell some discomfort. Also, it is nearly imposible to push it in while stretching. Should I start to worry or should I folow my doc’s advise: “If you can live like this – live”
    Thanks again.

  35. Hello!
    my name is Nadav i’m from Israel, I’ve had a left clavicle fracture 7 years ago and it healed 2.5cm shorter, anyways as the time passed by i’ve noticed bilateral SCJ subluxation/dislocation.
    my right shoulder has a prominent, sticking out scj, not painful in rest, limited shoulder ROM is obvious and loss of strength especially when trying to throw a ball.
    my left side has no apparent scj prominence but it is painful and unstable, moves out of the socket and goes back into it’s place on daily tasks throughout the day.
    anyways, I felt like the clavicle issue was compromising my left scj, and restricting my glenohumeral movement and scapula mechanism..
    I’ve had surgery in the us 3 weeks ago by Dr. Mark Sanders.
    I don’t know how succesfull the surgery was cause I still have some of my symptoms but i’m giving time, I’m 22 now and I really can’t do any physical activity and In Israel no one is really competent in these kind of things.
    I found a doctor named Dr. Peter Millet who’s supposed to be an expert in fixing SCJ dislocations, subluxation http://drmillett.com/
    I don’t know how realstic i’m but I thought about saving money and go see him perhaps but It’s too risky since I might need to stay for check-ups and that might be costly and unaffodable.
    do I have any alternative ? how far are we from stem cells to treat these type of injuries? i’m really clueless and depressed since I tried everything, I’ll be going for a 3d ct scan soon to see what’s going on with the structures of my shoulder.
    Good luck all of you!

  36. Theresa Taylor Libby says:

    Wow, your info has been very informative. I’m 58 y/o 5’4, 165 lbs female. Fairly fit and active. Was leisurely cycling 2 days ago, not paying attention and hit a sand patch which brought my cycle to a standstill and I fell to my Left landing on posterior acromion process. The impact pushed upward pressure on my Left SCM causing a tear at the proximal clavicular attachment and left sternal attachment. I have moderate bruising, swelling, and soreness. An MRI was done today with SCM noted to have tears but not retracted. So, I”m told surgery won’t be required. Am icing the area and wearing a shoulder sling. Initial pressure on my larynx has resolved. I will review the MRI with physician tomorrow. Have concerns about the degree of tears and whether I should keep a surgical option on the table sooner versus waiting to see if PT will help. I feel clicking at proximal clavicle area with any upward elbow movements. Of course the LEFT SCJ is up with a hematoma present and left sternal tenderness with deep breathing. I’ve used naproxen twice then stopped due to the hematoma present and to limit further bleeding. I take D3 5,000 u/day, Calcium, Omega3, stress B daily. Really would appreciate your thoughts. Mucho thx for reading. Theresa

  37. Theresa Taylor Libby says:

    Looked at MRI – have Lt. SCM tears and mild Pec major tear. My SCJ is anteriorly subluxed. No fractures! Looking at physical therapy and sling for support. Can’t really know if and when the SCJ subluxtion will resolve. In the meantime, this impacts on my exercise regimen…no jumpropes, cycling, etc. Looks like back to the basics = Walking!!

    • Moderator says:

      Hi Theresa,

      Unfortunately, your situation is way outside of my scope of knowledge. I never had to deal with accompanying muscle tears and I’m sure that will complicate the rehab process. The best thing you can do is follow your doctor’s advice and let enough time pass for the connective tissue to heal. Take it slow and easy; I hope you feel better!

  38. Theresa Taylor Libby says:

    Had a CT scan today…clavicle tip at SCJ is impact fracture into shaft with superior, anteriorly displacement. Ortho surgeon says risks of surgery are too high and may not be able to surgically correct. So, have to limit ROM, wear sling and/or figure 8-brace to limit adduction… 6-8 wks to heal…Not happy,

  39. Hello I’m 27, I have a had a traumatic posterior subluxation of the sc joint the doctor also said I broke the medial end of the c, I did it 8 weeks ago and the doctors I’ve seen have said it is rare what I have I feel very worried as I am a self employed kitchen and bathroom fitter so I can not work as the doctors have told me to do nothing I’ve been wearing a fig 8 brace up until Monday when I seen a authopedic doc. He said I could remove the brace now when I told him I still had pain in the joint and probs lifting and sleeping all he had to say was it will be like that for a long time and when I questioned him about returning to work all he had to say was come back in 5 weeks and we will talk then. I still have pain in the joint (on a 1-5 around a 2) on a day to day (no strain), I have no exercises to do and feel abit worried about doing any as it may put me back I feel a bit in the dark and also a bit useless as I’m not sure about trying to work or go to the gym (sensibly), even picking my little boy up any advice or hope would be appreciated

    • Moderator says:

      I am hesitant to recommend anything because posterior dislocations of the SCJ are potentially life threatening. It will take months for the ligaments to heal; the bone will heal quicker. You may develop post-traumatic osteoarthritis in the joint. It is too early to tell. The pain may be present for quite some time after such a traumatic injury. I had pain for over a year in my case. In your case, I would pay close attention to your doctors and wait until they tell you the joint is stable enough for you to return to work. The pain may be decreased by a corticosteroid injection or perhaps a referral to a pain management doctor. It may take quite some time for the joint to “cool off” so to speak and not cause as much pain. The bottom line here is to listen to your doctors and not risk any further injury or exacerbation of symptoms.

  40. Ok,

    A couple things:

    I myself have SC issue due to an AC 3rd degree separation.

    A lot of my issues are extreme tightness and pain along my SC and subclavicus. Also at times radiating down my biceps.

    Being a powerlifter I know that I should starting thinking about getting a SS Squat bar and a swiss bar for my modifications…

    One corrective exercise that I have found helpful for myself is forearm wall slides (not to be confused with scapular wall slides). This help with my depressed and winging scapula as protraction usually make my pain worse.

    The other thing that is unique to me is that my SC joint builds pressure and “pops”. Sometimes this helps, but lately not so much.

    I look forward to discussing more about this in the future.

    Best,

    Mike ATC, CSCS

    • Moderator says:

      The safety squat bar sounds like a great idea and I wish my gym had one. I don’t think the Swiss bar is worth getting and here’s why: yes, it decreases internal rotation at the GHJ and decreases impingement, but it also allows for a greater range of motion; that’s great if you’re healthy but unneeded for someone with a grade III ACJ separation and SCJ issues. You’d be better served by performing neutral grip DB floor presses; you get the best of all worlds. Stabilization from the DB’s, neutral grip to decrease impingement, and limited range of motion to prevent aggravating past injuries.

  41. Back in 1997, I was hit from behind and knocked to the floor with my arms above my head during a high school basketball game.I was told that I had dislocated my clavicle at the joint with the sternum. However, the specialist I saw told me he only saw these injuries at most once a year and never in a female. Since I still have pain on occasion, I was wondering if there is a way to know if it is an anterior or posterior dislocation based on how the injury occurred? I believe carrying around my child has caused some of the worsening in the pain. Thanks!

    • Moderator says:

      A posterior dislocation would have likely caused a choking sensation, flushing of the face, or a change in your voice due to the compression of structures that lie behind the manubrium. It is impossible for anyone to diagnose you over the internet. Please see an orthopedic surgeon to determine if you still have any residual instability and in which direction. Your mechanism of injury could have caused either of them. When you were hit from behind, it could have forced your shoulder girdle into protraction and caused a posterior dislocation, while falling on an outstretched hand above your head would cause an anterior dislocation. It is best to consult an orthopedic surgeon and discuss the current discomfort your are experiencing.

  42. Dustin Smith says:

    I wrote about my SC joint here back in May and wanted to give an update. My SC joint is slowly recovering and I am finding I am slowly upping the intensity on exercises like squats and deadlifts. I just did an 855 yoke walk today without pain! There are some exercises that still cause me discomfort though such as benching and barbell back squats, so I avoid them and substitute barbell back squats with cambered bar back squats. I feel like I am finally recovering and able to move heavy weights still. The only thing that pisses me off is my SC joint gets aggrevated with front squats and I love them, but can’t find a good substitute for them. I think I am going to fight with myself and leave them out for a few months and see if recovery improves. Since I have been dealing with this injury for over a year I pretty much know every exercise I can and cannot do just from experiementing. The good news is I can still train all my Strongman events!. I substitute deadlifting with trap bars deadlifts, farmers deadlifts, and car deadlifts. Doing holds with these exercises also helps tremendously. I think my back is stronger than it has ever been because of how tight I have to be when performing exercises to protect my SC joint. It is almost a blessing in disguise for me because my upper back was a weak point at one time, now I am hitting PR’s.

    Another thing I wanted to mention is how Mark Bell’s Slingshot has allowed me to do push ups and dips with no pain! ( I couldnt and wouldnt do those exercises before because of the pain and discomfort). I think this is a great rehab tool.

    If there are any other strength athletes here or just anyone wanting to get stronger but your SC joint issues are holding you back, post up your question and I will help through my experience however I can. I know how frustrating this injury can be. This site has been great to me and truly helped to rehab me back to lifting heavy weights again and setting PR’s.
    I feel as I am almost healed as long as I can keep front squats out of my training :)

  43. Dustin Smith says:

    Another thing I forgot to mentions is I recently started using a liquid glucosamine/chondroitin/msm product for about a month and my SC joint has been feeling better since then. Now there are too many variables to pinpoint just that to helping me recover, but if your out of options its worth a try. Make sure you get the liquid as I feel it works alot better than the pill form. I experiemented with the pills years ago and didn’t notice anything from them.(I remember they were rock hard, so they probably were not getting digested anyway)

  44. Hi,
    This has been very helpful.
    I am experiencing pain in this joint. When I feel how one side compares to the other – there is a noticeable dip.
    Had no idea this sort of thing could be an atraumatic cause – I assumed I had done something major that I just missed.
    I am taking a self defence class (Krav Maga). Looking back it was after a few weeks of learning the ‘elbowing’ techniques that I began to experience this collarbone discomfort. Just read over some of the comments and replies – very enlightening.

    Sitting here – I just did the looking up/away neck stretch and it felt terrific.

    Read further regarding cautionary movement for an elbow passes the plane of the shoulders – so I just did a slow “elbow strike #3″ and my collarbone/sternum just come apart and stick out! No pain just a separation.

    Guess I had better lay off those and go see my doctor. At least I have an idea what the heck is wrong.

    Appreciate the detail, feedback, stretches, etc.

  45. Claude Diehl says:

    This page was an incredible find for me. I have an SCJ injury.I got it by doing overhead barbell push presses with 150lbs. Ended up bouncing the weight off my upper chest and hit my SCJ. I had no idea what I did. I just knew my upper chest was sore. I do Crossfit. This exercise is popular. Long story short, 4 months went by and the pain did not go away. Very aggravating. I had an MRI done that showed no fracture and no subluxation which is a very good thing. (Does not explain why I suffered that grating/popping feeling but at least it was not as bad as it could have been). I feel much better today, grating is gone, but still not stable. MRI showed edema. Doc wants to give me a cortisone shot to speed up recovery. My question: Should I do this or just tough it out and let it heal? I have not lifted any weights or done a single push up in over 3 months. It’s driving me crazy. I’ve gotten a little soft and want to get back to working out again. I’m 50 years old. Please advise. I need to decide if I should let him inject me in that joint. Thank you very much. I’ve been really enlightened by this web page.

    • Moderator says:

      Hi Claude,

      This is a personal decision that you will have to make with your doctor. I can not tell you whether or not you should get the injection. I can tell you what I would do if I were in your position. Cortisone is a quick fix for inflammation. There is some research that raises a concern over Cortisone potentially increasing the rate of degeneration in a joint, but that is after multiple injections. I would be willing to experiment with one cortisone shot to put out the inflammation. If it doesn’t work, you just move on to the next treatment option. If you do not like the idea of injections, perhaps try a topical supplement called “Joint Force” by ErgoPharm. It was produced by Patrick Arnold and I have tried it myself. It is, in my opinion, an effective and noninvasive treatment for inflammation in superficial joints.

  46. Claude Diehl says:

    Thanks for the response. Do you mean a topical like Pennsaid?

  47. Omar Hernandez says:

    What a relief to find this page! On November 28th 2012 I was in a head on car accident into a wall at roughly 20-30 mph, my airbag did not deploy so the full force was from the seatbelt. I did not suffer from any noticeable pains other than a seat belt bruise.
    After about 2 weeks I started noticing cracking noises in my shoulder neck area, and when I throw my shoulders back and stretch, I get a pop on my SC joint. I can feel my manubrium sticking out. I have regular daily discomfort, and moderate to severe pain when exercising (dips seem to be the most difficult and painful exercise for me right now). Squeezing my shoulders forward, creating an inward pressure on my sternum causes pain. I try relentlessly stretching in every which way possible to somehow pop everything back into place, but no luck so far. I went to the hospital earlier today and from my description she also believes I have an SC Joint dislocation.
    My most concerning question to her was “How is this injury normally treated?” she replied “Well normally we would make an incision and insert a star shaped plate about 3mm in thickness, and it stays there permanently.”
    After hearing that from her, I’m having a pretty bad day and am discouraged from taking that route of treatment, as I am 24 years old, highly active and agile for my 190 lbs. I fear a plate screwed into my chest will be debilitating.
    I am scheduled for a CT scan of my chest on May 23rd for a definitive diagnosis. I will keep checking back here. Thanks for all the input and if anyone would like to contact me to share treatment methods I’d love to hear what works for you. My email is Omr.Hernandez@gmail.com

    • Moderator says:

      Hi Omar,

      I’m sorry you had to go through all of that; it sounds terrible. I don’t think the nurse knew what she was talking about. No one is going to stick a plate in your chest permanently for an SCJ dislocation, especially at your age. Now what I have heard of is the use of a Balser plate to immobilize the joint and keep it reduced while the connective tissues heal, but it is removed after healing takes place. If instability is a real problem and it affects your lifestyle significantly, then your doctors may discuss reconstruction of the joint. It can be reconstructed with biological or synthetic materials; that is largely up to the surgeon’s preference. I hope the CT scan shed some light on whatever seems to be afflicting you. Keep me posted and let me know how everything turns out. I wish you the best.

      -Scott

  48. Excellent, excellent, excellent website. This is awesome info.

    My Left clavicle has been aching for a bit lately. I’ve noticed a get a sharp pain whenever I protract my scapulae (top of a pushup, or bottom of a dumbbell row).

    I feel better whenever my shoulder blades are neutral, or even retracted. I might seek out my old doc to get a session or two of prolotherapy to tighten up the SC joint.

    And, I am correct in assuming that scapular depression (pullups) and scapular elevation (overhead presses) is fairly safe for the sternoclavicular joint, as long as it’s done properly???

    • Moderator says:

      It’s all relative to the symptoms you’re experiencing. None of the movements are inherently dangerous, only when combined with compromised passive restraints. Just make sure everything you’re doing is slow and controlled with careful attention paid to how you’re feeling. If you experience pain, stop what you’re doing and adjust accordingly.

  49. Glad to have found this website and read different SCJ stories. I had a road bicycle accident a month earlier. There were no fractures but neck, shoulder and arm muscle trauma.

    CT scan showed that my right SCJ is subluxed/dislocated anteriorly. The orthopedic said that I don’t have to be bothered about it. Just put on some Loxonin plaster. Two orthopedics said the same thing.

    My right SCJ appeared to be “bigger” and higher than the left. I am able to lift my right arm, but not extremely straight. When I lift my arm to the front, the Subscapularis muscle came so much further out than the left. Putting on/off clothes was quite challenging until last week, but the pain might have also been at the clavicle scapula end of the shoulder? Now, I can’t use much strength, but there was no pain doing the first two motions that I described.

    The beginning of this article mentioned 3 outcomes after joint reduction. The second case being healed, subluxed, stable. I would like clearer definition of all the 3 terms.

    With less pain now, is my SCJ considered healed?
    It still seemed “bigger” and higher than the left. How different is subluxation from dislocation?
    I can move my arms around doing normal light-weight chores. Is that considered stable?

    I am considering to consult a chiropractor because, despite what the orthopedic said, I highly doubt I can return to cycle, golf, and whatever sports I might pick up in the future, in this SCJ condition. Or can I?

    Thanks for reading.

    • Moderator says:

      When I say the joint is healed, subluxed, and stable, I am referring to an abnormal position of the medial end of the clavicle. In many cases it will sit slightly more anterior, but it does not slide in and out of the manubrial notch. Your joint is considered healed when it is pain free and you are able to engage in your daily activities of living without restriction.

      A subluxation is an incomplete or partial dislocation. A dislocation is the complete disruption of ligamentous support. I would not consult a chiropractor; I would consult a physical therapist who will strengthen your shoulder girdle and increase scapular stability. Ask your PT if you can return to those sports and then progress very slowly.

  50. great information !

    Would anybody know of support braces/wraps or of any taping techniques to help support the SC joints.

    My SC joint pops out, usually while asleep. I wake up with it, am able to push it back and its fine.

    My work does not allow me to rest it. I hike dogs on leash and the last year or so my shoulders and elbows are feeling it.
    But the SC joint sublaxation is bothering me and its getting harder to push it back.

    Thanks !!

    • Moderator says:

      There really isn’t any effective taping method for the SCJ. I Have played around with different configurations and they just don’t offer the level of support needed. I would recommend you examine which positions are causing it to sublux while you’re asleep and modifying your sleep positions accordingly.

  51. I know your article is only discussing anterior SCJ dislocations and not posterior SCJ dislocation but I’m hopeful you can answer a few questions about posterior SCJ dislocation. Finding any information on Posterior seems to be next to impossible.
    I recently had to have surgery for posterior SCJ dislocation – not a fun dislocation. I feel at a loss on knowing what to do to recover from this. My doctor told me not to lift anything over 5lbs (common sense) I’m not. However, I’ve noticed now that I’m 5 weeks out I’m getting more pain then normal in my shoulder and down my arm – not at the incision. I’m hoping this is the nerves trying to repair from the surgery. No one has really told me how long recovery is and when or if I can start any physical therapy. Any ideas on recovery time and if this is something you do physical therapy for? From everything you’ve shown (by the way great info) I believe these are exercise I could do at this time.
    I am so ready to sleep on my sides again and start running again.
    Thanks for any advice you feel you can give.
    B-

    • Moderator says:

      Hi Brandie,

      I’m not in a position to give you medical advice since I’m not a doctor, but your symptoms sound like thoracic outlet syndrome to me. I would consult a physical therapist to attain a proper diagnosis and treatment plan. I would not begin any exercise regimen without being cleared by your physician.

  52. Lisa Perry says:

    After reading all of these conversations, I am feeling somewhat better about my son’s recovery. He is 15 and has a dislocated SC joint on his right side. We think this happened when he fell off his four wheeler, however, he also has had a huge growth spurt and I’m not sure if that has anything to do with it? He has been in a sling with a very restrictive lifestyle. No driving, hunting, swimming, jogging, etc. very difficult for an active boy. We went back yesterday for a recheck. SC joint still popping when raises his arm up but no pain. Doctor said he could resume activities. If he has pain to stop that activity. He is on the swim team for his high school and has missed the season. And skeet shooting and hunting are about to begin. Do you think shooting a rifle will injure his SC joint? Is swimming out for him altogether? And there is school PE…any suggestions on how to handle that? Should he do push ups? Any helpful advice is much appreciated!

    • Moderator says:

      Hi Lisa,

      I think he should progress slowly with physical activity. If the joint is actually popping in and out (subluxing) when he raises his arm, then I would give it a few more weeks and see if it stabilizes a little more; it really depends how long the joint has had a chance to heal. If he wants to return to hunting, then I would recommend using a .22 before a 30-06 or a shotgun to gauge his response to the recoil. I would return to swimming if his joint was stable and pain free. Once again, progress slowly, and make sure he tapers his work load up. Start with easy strokes before trying the butterfly. As far as pushups are concerned, I would perform them with a limited range of motion. It’s actually the way I perform them now. Take a block and place it under his chest so when he is in the bottom position, his upper arm is parallel with the plane of his body. You don’t want the elbows to travel behind the plane of the body, since that would put a lot of stress on the healing ligaments. For school PE, I would tend to shy away from overhead sports. Please let me know if you have any other questions. Good luck!

Leave a Reply

*

Add video comment