Don’t Forget the SC-Joint

Soft tissue therapy and training of the shoulder has grown in leaps and bounds over the past decade.  While some may still be limiting their treatments to isolated soft tissue techniques at the site of pain and theraband exercises for internal and external rotation most have moved on to include a more holistic and full body approach.

The role of the scapula and thoracic spine are always discussed in the movement of the glenohumeral joint as limitations in movement here will translate to aberrant shoulder movement.  It is commonly talked about now that the thoracic spine needs to have its mobility restored so that the scapula can display optimal stability thus allowing the glenohumeral joint to produce safe and efficient mobility.

The Sternoclavicular Joint

One joint that seems to constantly get overlooked in the equation is the sternoclavicular (SC) joint.  The SC-joint is a true joint and is formed by the articulation between the sternum and the clavicle.  The distal end of the clavicle is where the acromioclavicular (AC) joint is formed, a union between the acromion process and the clavicle.  The AC-joint , while often discussed in the same sentence as shoulder impingement where structures are being compressed underneath the subacromial space, also is required to move during elevation of the upper extremity.  Thus, the movement at the distal end of the clavicle via the AC-joint during shoulder elevation causes a necessary movement of the clavicle and the SC-joint which, if not present can create issues with overall shoulder mobility.

Assessment of Clavicular Movement

The SC-joint should be assessed for both resisted abduction, which also produces a posterior rotation of the clavicle, and posterior movement during horizontal flexion of the shoulder.

Assessment of Abduction

With the client either seated or supine lying, place your index fingers on the superior aspect of the medial clavicle.  Ask the client to perform a shrugging movement while maintaining palpation of the clavicle and evaluate for caudad movement.  Failure of the SC-joint to move in a caudad direction during abduction would indicate a possible restriction.

Assessment of Horizontal Flexion

With the client supine lying, ask them to straighten their arms out toward the ceiling and place their palms together (like a prayer).  Again, palpate both SC-joints with your index fingers and ask the client to push their hands toward the ceiling simultaneously (shoulder protraction).  Assess the joint for movement in a posterior direction, moving toward the table.  Failure of the SC-joint to make this posterior movement during horizontal flexion would indicate a possible restriction.

Treatment of a restricted SC-joint

Depending on your level of training and scope of practice some therapists may choose to perform a high velocity maneuver to improve SC-joint function and shoulder function.  However, being a licensed massage therapist does not afford me this option however I have found the muscle energy techniques (post isometric relaxation) for this joint to be effective.  The client is asked to use their own muscular effort as we, the therapist, apply gentle stretching.  Another thing I like about these techniques is that they are pain free techniques and should not be performed if they produce any sort of pain or discomfort.

Restricted Abduction

• With the client seated stand to the side of the restricted SC-joint
• Place the thenar eminence of the hand closest to them on the superior aspect of the medial clavicle
• With your other arm, gasp the client’s elbow and abduct their arm to about 90 degrees with the shoulder externally rotated.
• Instruct the client to apply gentle adduction (approximately 20% effort) into your hand for 5-7seconds
• Upon relaxation of the muscular effort passively abduct their arm to the next barrier of resistance while simultaneously maintaining a firm (pain-free) pressure on the medial aspect of their clavicle with your thenar eminence
• Repeat this process until freedom of movement is attained at the SC-joint

Restricted Horizontal Flexion

• With the client supine lying stand to the side opposite that of the SC-joint you have to treat
• Place the hypothenar eminence of the hand furthest from the table over the medial end of their clavicle applying firm (pain-free) pressure towards the floor
• Place the hand closest to the table underneath their shoulder gently grasping their scapula
• Ask the client to place their arm around the back of your neck or shoulder
• With their arm behind your neck or shoulder gently lean back to take out the slack of their extended arm while simultaneously lifting the scapula gently from the table
• Ask the client to then attempt to pull you towards them – pulling against your neck or shoulder – with an effort of approximately 20% of muscular force and maintain that resistance for 5-7seconds
• Upon relaxation of the muscular effort, repeat the process of leaning back and lifting the scapula gently off the table to take out more of the slack while simultaneously maintaining pressure on the medial aspect of the scapula
• Repeat this process until freedom of movement is attained at the SC-joint

Patrick Ward
patrick@optimumsportsperformance.com