BREASTBONE (STERNUM) SPRAIN AT THE COLLARBONE (CLAVICLE) (Sterno-Clavicular Sprain)
DEFINITION--Violent overstretching of one or more ligaments in the sterno-clavicular joint where the collarbone meets the breastbone. Sprains involving two or more ligaments cause considerably more disability than single-ligament sprains. When the ligament is overstretched, it becomes tense and gives way at its weakest point, either where it attaches to bone or within the ligament itself. If the ligament pulls loose a fragment of bone, it is called a SPRAIN-FRACTURE. There are 3 types of sprains:Mild (Grade I)--Tearing of some ligament fibers. There is no loss of function.
Moderate (Grade II)--Rupture of a portion of the ligament, resulting in some loss of function.
Severe (Grade III)--Complete rupture of the ligament or complete separation of ligament from bone. There is total loss of function. A severe sprain requires surgical repair.
BODY PARTS INVOLVED
Ligaments of the sterno-clavicular joint.
Tissue surrounding the sprain, including blood vessels, tendons, bone, periosteum (covering of bone) and muscles.
SIGNS & SYMPTOMS
Severe pain at the time of injury.
A feeling of popping or tearing in the collarbone area.
Tenderness at the injury site.
Swelling in the collarbone area.
Bruising that appears soon after injury.
Stress on a ligament by a force that thrusts the shoulder sharply forward, temporarily forcing the sterno-clavicular joint out of its normal location.
Falling on an outstretched hand.
RISK INCREASES WITH
Contact sports such as boxing or football.
Previous breastbone or collarbone injury.
Poor muscle conditioning.
Inadequate protection from equipment.
HOW TO PREVENT
Warm up before practice or competition.
Wear proper protective equipment, such as shoulder and chest pads.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Application of a cast, tape, elastic bandage or special brace.
Self-care during rehabilitation.
Physical therapy (moderate or severe sprain).
Surgery (severe sprain).
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the the shoulder, chest and clavicle to rule out fractures.
Prolonged healing time if usual activities are resumed too soon.
Proneness to repeated injury.
Inflammation at the ligament attachment to bone (periostitis).
Prolonged disability (sometimes).
Unstable or arthritic joint following repeated injury.
PROBABLE OUTCOMEIf this is a first-time injury, proper care and sufficient healing time before resuming activity should prevent permanent disability. Ligaments have a poor blood supply, and torn ligaments require as much healing time as fractures. Average healing times are:
Mild sprains--2 to 6 weeks.
Moderate sprains--6 to 8 weeks.
Severe sprains--8 to 10 weeks.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDUse instructions for R.I.C.E., the first letters of REST, ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
CONTINUING CAREIf the doctor does not apply a cast, tape or elastic bandage:
Continue using an ice pack 3 or 4 times a day. Place ice chips or cubes in a plastic bag. Wrap the bag in a moist towel, and place it over the injured area. Use for 20 minutes at a time.
After 72 hours, apply heat instead of ice if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments or ointments.
Take whirlpool treatments, if available.
Massage gently and often to provide comfort and decrease swelling.
For minor discomfort, you may use:
Aspirin, acetaminophen or ibuprofen.
Topical liniments and ointments.
Your doctor may prescribe:
Stronger pain relievers.
Injection of a long-acting local anesthetic to reduce pain.
Injection of a corticosteroid, such as triamcinolone, to reduce inflammation.
ACTIVITYResume your normal activities gradually after clearance from your doctor.
DIETDuring recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
Begin daily rehabilitation exercises when pain subsides.
Use ice massage for 10 minutes before and 10 minutes after exercise. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have symptoms of a moderate or severe sterno-clavicular sprain, or a mild sprain persists longer than 2 weeks.
Pain, swelling or bruising worsens despite treatment.
You experience pain, numbness or coldness in the shoulder, arm or below the injury site.
Skin turns blue, gray or a dusky color beyond the cast or sling.
The collarbone moves backward out of normal position.
Any of the following occur after surgery:
Increased pain, swelling, redness, drainage or bleeding in the surgical area.
Signs of infection (headache, muscle aches, dizziness, or a general ill feeling with fever).
New, unexplained symptoms develop. Drugs used in treatment may produce side effects.