The Shoulder

Shoulder Girdle

Posterior sternoclavicular syndrome

Clinical Findings

This rare disorder arises spontaneously in middle-aged people.
It may cause some misleading signs and symptoms.

There is unilateral pain at the base of the neck ( trapezius - medial angle of the scapula). The pain is only felt posteriorly and not at the sternoclavicular joint itself.

The localisation of the pain suggests a lesion of the cervical spine, but clinical examination of the neck is completely negative : full and painless motion and painless resisted tests.

Both active and passive elevation of the arm is painful.

Clinical examination of the shoulder girdle proves to be positive:

pain on active and passive elevation of the scapula
pain on protraction (abduction) of the scapula
resisted movements of the shoulder girdle are painless

Often the passive horizontal adduction of the shoulder is painful as well. (the pain is felt at the base of the neck).

Treatment

One to two infiltrations with 20 mg of triamcinolone at the posterior sternoclvicular ligament is usually helpful.
!!! Due to the localisation of some vital structures immediately posterior to the sternoclavicular joint, the infiltration must be performed with care. Technique

Preliminary Examination / Interpretation / Pathology of Shoulder Girdle / Sternoclavicular Lesions