Ligaments
| LIGAMENT | DESCRIPTION | ATTACHMENT | ROLE |
| Anterior Sternoclavicular Ligament [6] [ ... | Broad band of fibers, covering anterior ... | Superior & Anterior Aspect of Sternal En ... | Reinforces the capsule anteriorly Limits ... |
| Posterior Sternoclavicular Ligament [6] ... | Broad band of fibers, covering posterior ... | Superior & Posterior Aspect Sternal End ... | Reinforces the capsule Posteriorly Limit ... |
| Costoclavicular Ligament [6] [2] | Anchors Inferior Surface of the Sternal ... | Anterior lamina: laterally from first ri ... | Limits the elevation of the pectoral gir ... |
| Interclavicular Ligament [6] [2] | Connects Sternal Ends of Each Clavicle w ... | Sternal end of one clavicle to sternal e ... | Strengthens the capsule superiorly Resis ... |
What are the three articular surfaces of the sternoclavicular joint?
What is the synovial saddle joint that connects the sternum with the clavicles?
What are the two sets of ligaments that provide stability?
What nerve innervates the sternoclavicular joint?
What is the function of the sternoclavicular joint?
Which ligament runs from the sternal end of the clavicle to the anterosuperior surface?
Which end of the clavicle is larger?
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What ligaments support the sternoclavicular joint?
Other ligaments contributing to the stability of the SC joint are the interclavicular ligament which facilitates medial traction of both clavicles, and the costoclavicular ligament which mediates bilateral clavicle and anterior first rib stability.
What connects to the sternoclavicular joint?
The sternoclavicular (SC) joint is the linkage between the clavicle (collarbone) and the sternum (breastbone).
What 3 muscles attach to the clavicle?
Muscular attachments to the clavicle include the sternocleidomastoid, pectoralis major, and subclavius muscles proximally and the deltoid and trapezius muscles distally.
Which ligament is strongest in clavicle?
The acromioclavicular ligament forms a strong connection between the clavicle and the scapula acromion, which restricts movement about the clavicle at its acromial end.
Why is the sternoclavicular joint important?
The sternoclavicular joint is required to accommodate the movements of the upper limb, and thus has a high degree of mobility. However, it also requires much stability, as it is the only connection between the upper limb and the axial skeleton.
What is the function of the costoclavicular ligament?
The costoclavicular ligament acts as a pivot for movements of the clavicle. You can feel this if you palpate the sternal end of your clavicle and shrug your shoulders, you should feel the sternal end moving inferiorly.
What is joint capsule?
Joint Capsule. The joint capsule consists of a fibrous outer layer, and inner synovial membrane. The fibrous layer extends from the epiphysis of the sternal end of the clavicle, to the borders of the articular surfaces and the articular disc.
What is Fig 1?
Fig 1 – The articulating surfaces of the sternoclavicular joint.
Which ligaments are used to strengthen the capsule?
There are four major ligaments: Sternoclavicular ligaments (anterior and posterior) – these strengthen the joint capsule anteriorly and posteriorly. Interclavicular ligament – this spans the gap between the sternal ends of each clavicle and reinforces the joint capsule superiorly.
Which ligament binds the 1st rib?
Costoclavicular ligament – the two parts of this ligament (often separated by a bursa) bind at the 1st rib and cartilage inferiorly and to the anterior and posterior borders of the clavicle superiorly. It is a very strong ligament and is the main stabilising force for the joint, resisting elevation of the pectoral girdle.
Which joint provides stability?
The ligaments of the sternoclavicular joint provide much of its stability. There are four major ligaments:
What happens to the clavicle during elevation?
During elevation, the clavicle rotates upward on the manubrium and produces an inferior glide to maintain joint contact. The reverse actions happen when the clavicle is depressed. The motions are usually associated with elevation and depression of the scapula. The elevation is assumed to be 45 degrees and the depression to be 10 degrees.
What is the articulation of the clavicle and the manubrium of the sternum?
The Sternoclavicular Joint (SC joint) is formed from the articulation of the medial aspect of the clavicle and the manubrium of the sternum. The SC joint is the only true articulation connecting the upper limb to the axial skeleton, and that it’s the least constricted joint in the human body.
What is the sternoclavicular joint?
The Sternoclavicular Joint (SC joint) is formed from the articulation of the medial aspect of the clavicle and the manubrium of the sternum. The SC joint is the only true articulation connecting the upper limb to the axial skeleton, and that it’s the least constricted joint in the human body. It is one of four joints that compose the Shoulder Complex. The SC joint is generally classified as a plane style synovial joint and has a fibrocartilage joint disk. The ligamentous reinforcements of this joint are very strong, often resulting in a fracture of the clavicle before a dislocation of the SC joint.
How does the clavicle move when the arm is raised over the head?
When the arm is raised over the head by flexion the clavicle rotates passively as the scapula rotates approximately around 40-50degrees. This is transmitted to the clavicle by the coracoclavicular ligaments. this movement is allowed by the relative slackness of the ligaments in this position.
What is the interarticular fibrocartilage disc?
The inter-articular fibrocartilage disc separates the joint into two compartments. The first compartment lies between the manubrium and the disc and the second lies between the disc and the clavicle.
Which part of the sternum articulates with the first rib?
The manubrium is the most superior portion of the sternum which articulates with the first rib of both sides, the upper part of the second costal cartilage and clavicle forming the Sternoclavicular Joint. The manubrium is quadrangular and lies at the level of the 3rd and 4th thoracic vertebrae.
Where does the sternoclavicular ligament attach to the clavicle?
This ligament originates from the junction of the first rib and sternum and passes through the SC joint and attaches to the clavicle on the superior and posterior side. The anterior and posterior sternoclavicular ligaments restrain anterior and posterior translation of the medial clavicle.
What is saddle joint 3?
There are two non-congruent articular surfaces forming a saddle joint 3: The articular surfaces are covered with fibrocartilage (rather than hyaline cartilage as in most other synovial joints ). The joint space is divided into two separate recesses by a fibrocartilage articular disc 1,2.
What joint joins the upper limb and the axial skeleton?
Sternoclavicular joint. The sternoclavicular joint is a synovial joint between the medial clavicle, manubrium and the first costal cartilage that joins the upper limb with the axial skeleton .
What is an articular disc?
articular disc. flat and oval in shape. made of fibrocartilage (like the menisci of the knee and labrum of the hip and shoulder) attached to the joint capsule anteriorly and posteriorly, first costal cartilage inferiorly and the clavicle superiorly.
What is the ISBN for Disorders of the Shoulder?
3. Disorders of the shoulder. Lippincott Williams & Wilkins. ISBN:0781756782. Read it at Google Books - Find it at Amazon
Which ligaments are involved in the stability of the joint?
Due to the non-congruent articular facets, much of the joint stability comes from surrounding ligaments 3,4 : anterior and posterior sternoclavicular ligament: thickenings of the joint capsule. interclavicular ligament: between the superomedial ends of the clavicles. costoclavicular ligament.
Which cartilage is attached to the joint capsule anteriorly and posteriorly?
attached to the joint capsule anteriorly and posteriorly, first costal cartilage inferiorly and the clavicle superiorly
What causes posterior dislocation of the SCJ?
Posterior dislocation of the SCJ can be caused by a direct force over the anteromedial aspect of the clavicle or an indirect force to the posterolateral shoulder, forcing the medial clavicle posteriorly. Anterior dislocation is usually due to a lateral compressive force to the shoulder girdle, which results in sparing of the posterior capsule but rupture of the anterior capsule and often part of the costoclavicular ligament. As with all high energy injuries one should have a high index of suspicion for associated injuries[8].
What is the SCJ?
The SCJ is a diarthrodial saddle type synovial joint which is inherently unstable[8,9]. Less than 50% of the medial clavicular surface articulates with its corresponding articular surface on the manubrium sterni. Its stability is therefore derived from intrinsic and extrinsic ligamentous structures surrounding the joint[8]. These structures include the costoclavicular (rhomboid) ligament, which is divided into an anterior and posterior fasciculus. The anterior fasciculus resists superior rotation and lateral displacement and the posterior fasciculus resists inferior rotation and medial displacement. The interclavicular ligament (extrinsic) and the posterior and anterior sternoclavicular ligaments also aid stability along with the anterior and posterior capsular ligaments. In 1967, Bearn[10] conducted an anatomical study looking at the structures which were of paramount importance in maintaining SCJ stability. By dividing all the ligamentous structures except the capsular restraints there was found to be no effect on the position of the clavicle. However dividing the capsular ligaments in isolation resulted in a superior migration of the medial clavicle. This work was repeated by Spencer et al[6] in 2002 and showed that the posterior capsule is the joints strongest ligamentous stabiliser. Sectioning of the posterior capsule resulted in 41% increase in anterior translation and a 106% increase in posterior translation. When the anterior capsule was cut in isolation this resulted in just a 25% increase in anterior translation and 0.7% increase in posterior translation. Therefore in reconstructive surgery close attention should be paid to the posterior capsule whether the dislocation is anterior or posterior[6].
What is the only bony articulation between the axial skeleton and the upper extremity?
The SCJ is the only bony articulation between the axial skeleton and the upper extremity[6]. The clavicle is unique in the sense that it is the first bone in the human body to ossify, usually in the fifth gestational week but the medial end of the clavicle is the last to fuse, between ages 23-25[7]. Therefore in some patients under 25, what is believed to be an SCJ dislocation is actually a fracture of medial clavicular physis and owing to the remodelling potential of such paediatric injuries can usually be managed conservatively[8].
What is sternoclavicular joint dislocation?
Sternoclavicular joint dislocations are rare and represent only 3% of all dislocations around the shoulder [1]. Despite the uncommon nature of these injuries they can present the clinician with uncertainty regarding their investigation and management. Dislocations may be either traumatic or atraumatic. Those that are due to trauma may dislocate anteriorly or posteriorly, with anterior dislocation being approximately nine times more common. The main concern with a posterior dislocation is the risk of compression to the mediastinal structures which may be life threatening, requiring expedient intervention[2]. Atraumatic dislocations and subluxations may occur in patients with collagen deficiency conditions such as generalised hypermobility syndrome and Ehlers-Danlos[3,4], or clavicular deformity, abnormal muscle patterning, infection or arthritis. The purpose of this educational review is clarify the current thinking regarding the diagnosis of all types of sternoclavicular joint (SCJ) dislocation and how these challenging injuries can be managed[5].
What is the Stanmore triangle?
It can therefore be thought of as instability, which can be acute, recurrent or persistent. The Stanmore triangle, which is commonly used for glenohumeral instability, has also been applied to instability of the SCJ. The triangle consists of 3 polar groups; type I traumatic structural, type II atraumatic structural and type III muscle patterning, non structural. Patients may move around this triangle with time, for example a patient may initially present with a clear traumatic event but then as a result of abnormal movement due to pain may develop abnormal muscle patterning[8].
What is type I instability?
With type I instability there is a clear history of trauma, whether this is a fracture of the medial clavicle or SCJ dislocation. With Type II there is no history of trauma but structural change within the capsular tissue, which may be as a result of repetitive microtrauma. In type III there is no structural abnormality and it is the abnormal contraction of muscles, namely pectoralis major, which cause the SCJ to sublux or dislocate[8].
How to reduce SCJ?
If the patient presents with an acute anterior dislocation of their SCJ (within 7-10 d) then these can be reduced by closed reduction with sedation or under general anaesthetic in the operating room. The patient is placed supine with a bolster placed between their shoulders. Traction is then applied to the affected upper limb in 90 degrees of abduction with neutral flexion and direct pressure is applied over the medial clavicle. Following reduction the arm should be placed in a polysling, maintaining scapular protraction for up to 4 wk. Re-dislocation has found to range between 21% and 100%[17-19] which raises the question whether simple closed reduction without ligament reconstruction is sufficient. One can also question whether reduction of an anterior dislocation is necessary at all.
What are the three articular surfaces of the sternoclavicular joint?
The sternoclavicular joint is a connection of three articular surfaces; the sternal end of the clavicle, the clavicular notch of the manubrium of sternum and the superior surface of the first costal cartilage. The clavicular and sternal joint surfaces are convex and concave, respectively.
What is the synovial saddle joint that connects the sternum with the clavicles?
Sternoclavicular joint. The sternoclavicular joint is a synovial saddle joint that connects the sternum with the clavicles. It is the only true joint which connects the appendicular skeleton of the upper limb with the axial skeleton of the trunk.
What are the two sets of ligaments that provide stability?
Due to the lack of bony congruence, joint stability is provided by two sets of ligaments and the intra-articular disc. The ligaments are divided into; Intrinsic ligaments; anterior and posterior sternoclavicular ligaments.
What nerve innervates the sternoclavicular joint?
The sternoclavicular joint is innervated from two sources; superficially by the medial supraclavicular nerve (C3-C4; cervical plexus) and deeply by the nerve to subclavius (C5-C6; brachial plexus).
What is the function of the sternoclavicular joint?
The function of the sternoclavicular joint is to coordinate the movements of the upper limb with the core of the body. Thus allowing the upper limb to perform its full range of motion. Specifically, the movements of the sternoclavicular joint are sorted into three degrees of freedom; elevation - depression, protraction - retraction, ...
Which ligament runs from the sternal end of the clavicle to the anterosuperior surface?
The broad anterior sternoclavicular ligament runs from the anterosuperior surface of the sternal end of the clavicle to the anterosuperior surface of the manubrium and adjacent part of the first costal cartilage. This provides strong reinforcement to the anterior aspect of the joint.
Which end of the clavicle is larger?
The sternal end of the clavicle is also larger in size than the clavicular notch of the sternum, thus the medial end of the clavicle juts out superiorly above the upper border of the manubrium. Joint congruency is enhanced somewhat by the presence of a fibrocartilaginous intra-articular disc.