Dislocated Collarbone? Here’s 11 Easy Sternoclavicular Joint Rehab Exercises to Get Back to Work

Suppose you have experienced an injury resulting in pain or discovered a lump on the inner side of your collarbone near your voice box. In that case, it is likely due to sternoclavicular (SC) joint dislocation. Most cases of SC joint instability can be treated through non-operative exercise, although reconstruction surgery may be necessary for unstable dislocations. Unstable joint dislocations can be particularly difficult to manage without surgery, resulting in severe pain and discomfort.

However, post-operative physical therapy is essential for preventing joint stiffness and aiding recovery. In this article, I will cover the physiotherapy management and exercises necessary for effective recovery after sternoclavicular joint dislocation reconstruction surgery. These exercises will also assist in the conservative management of SC joint instability for those cases where surgery is not recommended.

Sternoclavicular joint exercises for dislocated collarbone

Sternoclavicular joint dislocation is rare and comprises 0.5% to 3% of shoulder girdle injuries¹. In this injury, the medial part of the clavicle (collar bone) is displaced from its joint. We call it anterior dislocation when it displaces and moves forward, and backward displacement is termed posterior dislocation. Among them, anterior dislocation is most common and posterior dislocation is rare.

The Sternoclavicular joint is at the base of our neck on the chest, just by the side of the sternum bone. Just palpate the bony prominence by the side of the voice box; it is a Sterno-clavicular joint.

The inner part of the clavicle bone and the sternum bone form this joint. It is a synovial type of joint surrounded by capsules and ligaments. This joint moves in four directions. Upwards, downwards, forwards, and backwards. It also occurs in rotational movement.

So, what led to this injury?

Causes of sternoclavicular joint instability

Diagnosis of the Sternoclavicular Joint Dislocation through X-ray is very difficult. This is because it is very difficult to visualize, but clinically, its diagnosis is simple. The point is that sternoclavicular dislocation is often associated with clavicle fracture.

The most common reason for this kind of dislocation is traumatic injury. Let us try to understand traumatic sternoclavicular dislocation with this case study. Sternoclavicular joint dislocation is common after a fall injury, and it may be after falling from a motorbike or falling on an outstretched hand. Let us try to understand with a case study.

A case study

Approximately four months ago, I fell off my pedal bike (20mph) and hit my shoulder hard on the ground. I had shoulder pain and went for rest in the next two weeks, then started swimming again for two weeks.

As days passed by, I noticed pain in my Sterno-Clavicular joint and a lump. Because of the pain, I discontinued all sports and outdoor activities and went to see the doctor. The doctor referred me for an X-ray. The X-ray report was normal (No fracture or abnormality was detected).

Within a few months, my Sternoclavicular joint becomes inflamed, and it remains throughout the day (whilst at work, nothing too laborious, but I drive for an hour each way, which could be irritating). Inflammation usually eases in the evening and at night (When I wake up in the morning, my Sterno-Clavicular joint is fairly flat and protrudes much less than later during the day).

Pain is minimal in the morning but worsens as the day goes on, and it “feels” as though it’s on the tip of the clavicle on the Sterno-Clavicular joint. When I rotate my shoulder, I feel a “clicking” noise from my Sterno-Clavicular joint. I’ve tried not to reach above shoulder height; the movement is not limited, and the pain is minor.

Rehabilitation protocol after sternoclavicular joint dislocation surgery

Physiotherapy rehabilitation should start the very next day after the surgery. The shoulder immobilisation is done using a shoulder sling, and it should be worn for at least six weeks. Even during immobilisation, the exercises are essential to prevent secondary complications such as disuse atrophy, muscle weakness, and shoulder, elbow, and wrist joint stiffness.

We can study rehabilitation protocol under two phases. The first phase is the early recovery phase, lasting from 0 to 6 weeks, and the second lasts from 6 to 12 weeks.

Early Recovery phase (Weeks 0 to 6)

After shoulder surgery, the affected area must be immobilized using a sling for at least six weeks. In the initial days after the surgery, there is a chance of developing swelling and pain in the area. To manage this, cryotherapy or the application of an ice pack is crucial.

The preferred method is active compression cold therapy, where the affected area is exposed to cold therapy for 30 minutes, followed by 60 minutes of rest to avoid skin irritation. This on-off cycle should be repeated throughout the day while the patient is awake¹.

After a sternoclavicular joint reconstruction, patients must avoid any movements involving scapular protraction and retraction, as well as scapular depression and elevation during the first six weeks. Carrying or lifting objects with the affected extremity is also not permitted.

Exercises during the early recovery phase

The early recovery phase is when the injured part is healing, so avoid any movement in the shoulder joint. But, it would help if you started exercising the joints distal to the shoulder, like exercising the elbow, wrist and finger joints. So, let us start with wrist flexion-extension exercises.

Wrist flexion-extension

When you have an arm sling on, it’s important to start exercising your wrist joint as soon as possible. One simple exercise you can do is called wrist flexion-extension. To perform this exercise:

1. Start by supporting your forearm on the arm sling.
2. Slowly move your wrist upward, away from the ground, while keeping your forearm supported on the sling. The movement should be slow and smooth, and you should move your wrist to the maximum point possible without causing any pain or discomfort.
3. Once you’ve reached the maximum point, slowly bring your wrist back down into flexion toward the ground.
4. Again, try to localize the motion to your wrist and avoid any unnecessary movement in the shoulder.
5. Repeat this motion, alternating between wrist flexion and extension, for at least 20 to 30 repetitions each time. If you can do more repetitions, that’s even better!

Doing this exercise regularly will help promote blood flow to your wrist joint, which can help speed up your recovery time and improve your overall range of motion.

Wrist circumduction

The next exercise is wrist circumduction. This exercise is performed with an arm sling, just like the previous exercise. Circumduction is a type of motion in which a body part is moved in a circular path over the joint.

1. To perform the exercise, begin by making your forearm stable. Using your opposite hand to hold just proximal to the wrist joint is recommended to give a stable support base to perform the circumduction.
2. Then, slowly and smoothly rotate your wrist in a circular motion.
3. Make sure to rotate your wrist clockwise 10 to 15 times and switch to anticlockwise.
4. To get the most out of the exercise, it is suggested to do it at least 20 to 30 times in a session. However, the more you do, the better.
5. You can perform this exercise whenever you have free time or watching television. Remember to take it slow and be gentle with your wrist.

Grip strengthening exercise

During the six weeks of sling immobilisation of your shoulder and forearm, it is common to experience a decrease in grip strength. However, you can do a simple exercise to help counteract this. Using a grip strengthening gel ball, you can strengthen your hand and forearm muscles.

1. To perform this exercise, place your forearm comfortably inside the sling and take the gel ball in your hand.
2. Squeeze the ball as tightly as possible, holding the squeeze for a few seconds before releasing it.
3. Repeat this squeezing motion as many times as possible whenever it is comfortable for you.

It is important to note that this exercise has no set routine. You can perform it as often as possible, whenever it is convenient for you. Regularly doing this exercise can improve your grip strength and help prevent disuse atrophy of the muscles around your wrist and forearm. Additionally, it can promote healthy blood circulation.

Elbow range of motion

Maintaining elbow joint mobility is crucial to prevent stiffness and maintain the arm’s functionality. One way to achieve this is to perform elbow joint exercises, which can initially be done passively with the help of the opposite hand. To do this exercise:

1. Start by supporting the forearm on an arm sling and holding the wrist with one hand.
2. With the other hand, gently bend the elbow joint to its maximum point of motion.
3. Then, slowly lower it back down. It is important to avoid applying excessive pressure while bending the elbow, as this can cause strain on the shoulder joint.
4. Repeat this exercise 10 to 15 times in a single session and aim to perform 2 to 3 sessions daily.

Over time, you can gradually increase the range of motion and decrease the support from the opposite hand until you can perform the exercise independently.

Shoulder flexion-extension

Shoulder joint range of motion is paramount to prevent shoulder joint restriction. Therefore, it is essential to start exercising on the 3rd week post-surgically while the forearm is still supported over the arm sling. This exercise is passive and requires the support of the other hand to perform shoulder flexion and extension passively. To start this exercise:

• Stand straight with your arms by your sides.
• Take your opposite hand and support the affected forearm by holding it at the wrist.
• Now, gently move the affected arm away from the body, taking it to a point where your pain permits. Hold this position for a few seconds, then slowly bring the arm back to its normal position.
• Next, gently and slowly bring the affected arm across the chest towards the body midline. Again, hold this position for a few seconds and slowly bring the arm back to its normal position.
• Repeat this motion alternately for 10 to 15 times in a session.

Ensure that the movement is slow, gentle, and within the pain-free range. It is important not to push beyond your limits as it may cause further damage to the shoulder joint.

Shoulder elevation

First, to perform the shoulder elevation exercise, ensure you are comfortably seated with your back straight and your feet firmly planted on the ground.

1. While your forearm is still in an arm sling, grasp your forearm at the wrist with your other hand.
2. Then, gently raise your arm forward until you feel your shoulder muscles engaging. Taking the arm to a point within the pain-free range is essential to avoid discomfort or injury.
3. Hold the position for a few seconds while maintaining proper form, and then slowly lower your shoulder back down to the starting position.
4. It is essential to perform the movement controlled, without any sudden or jerky movements that may cause injury.
5. Repeat this exercise 10 to 15 times per session to strengthen your shoulder muscles effectively.

Rehabilitation phase (Weeks 6 to 12)

At around six weeks after your surgery, your shoulder sling will be removed. From this point onward, it is important to start with full-fledged exercises for the shoulder. We will begin with full passive and active-assisted range of motion (AAROM) exercises, with active range of motion starting at eight weeks post-operation.

Until eight weeks post-op, only passive and AAROM exercises are permitted. The main objective of this phase is to restore the glenohumeral range of motion and promote proper scapulothoracic motion. We may need to restrict your exercise progression if you experience persistent or recurrent pain and/or swelling.

Shoulder wand/cane exercise for SC joint instability(weeks 6 to 8)

You will need a cane or wand to perform the active-assisted exercise for regaining the range of motion in your shoulder. I have covered these exercises in a detailed manner in one of my previous articles titled “4 Best Shoulder wand exercises for painful, stiff shoulder“. You can visit this link to learn those exercises. These exercises include:

1. Shoulder elevation
2. Abduction adduction of the shoulder
3. Shoulder flexion-extension.
4. Internal and external rotation of the shoulder.

Active ROM and light strengthening exercise (week 8 to 12)

By the 8th week, almost all pain and stiffness in the shoulder would have gone, and it’s the perfect time to shift from passive shoulder ROM exercises to active ROM exercises. Active exercises also promote muscle strengthening. As we progress with exercises, we can add a little weight to them to make it a light strengthening exercise. We can also start elbow exercises.

These sternoclavicular joint dislocation exercises include

• Active shoulder abduction adduction,
• Shoulder flexion-extension,
• Active elevation of the shoulder.

Strengthening exercises for sternoclavicular joint (week 13 to 20)

The focus of this rehabilitation phase is to increase the strength of the shoulder musculature with emphasis on proper scapulothoracic motion. Progression of weight and resistance level of the existing exercises is the focus of weeks 13 to 20. Now, patients may progress to full upper extremity weight-bearing activities of daily living without restriction. In one of our posts, I covered various strengthening exercises using a resistance band. Read this article, “5 Top Shoulder Strengthening Exercises with Resistance Band“, to gain more insight into it.

These exercises include:

1. Shoulder abductor strengthening exercise
2. Flexor strengthening exercise with resistance band
3. Strengthening exercise for internal rotators
4. External rotator strengthening exercise for shoulder
5. Shoulder retractor strengthening exercise

Sunit. S. Ekka

Dr Sunit Sanjay Ekka is a physiotherapist in practice for the last 15 years. He has done his BPT from one of the premium Central Government physiotherapy colleges, ie, SVNIRTAR. The patient is his best teacher and whatever he gets to learn he loves to share it on his Youtube channel and blog.