Sternoclavicular Joint Injury. he sternoclavicular joint is a diarthrodial joint composed of the sternum and clavicle. It is stabilized by the posterior capsular ligament which provides the most anterior-posterior stability and the anterior sternoclavicular ligament which restricts superior displacement. The costoclavicular ligament helps provide medial clavicle and anterior first rib stability. The interclavicular ligament passes over the sternum to provide medial traction of both clavicles. The inter-articular disc ligament attaches to the first rib and also provides stability of the sternoclavicular joint. In between the two articular surfaces and within the joint space is a fibrocartilaginous articular disc which functions as an important shock absorber. It is the only synovial articulation between the upper limb and axial skeleton. The subclavius muscle also supports the integrity of the joint. There are vital anatomic structures behind the clavicle which include the innominate artery and vein, vagus nerve, phrenic nerve, internal jugular vein, trachea, and esophagus. The medial clavicle physis appears in late adolescence and does not ossify until the age of 25 Movement of the joint occurs from transmission of movement from the scapula and the rest of the shoulder girdle. In abduction, the sternoclavicular joint has 35 degrees of range. Anterior-posteriorly it can move 70 degrees. There is also a rotational component. Injuries to the sternoclavicular joint can be traumatic or atraumatic. In traumatic injuries, the mechanism is usually a high energy injury such as a motor vehicle accident or injury during contact or collision sports. A sprain of the joint can occur when no laxity or instability occurs. Sternoclavicular joint injuries are categorised as the following 3 stages: Stage I: Sprain (ligaments intact) Stage II: Subluxation (tearing of sternoclavicular ligaments; costoclavicular ligaments intact) Stage III: Dislocation (tearing of all ligaments) Instability can further be described as follows: Degree: subluxation or dislocation Direction: anterior or posterior Etiology: traumatic or traumatic (congenital, developmental, spontaneous) Severity: sprain, subluxation, dislocation Duration: acute, chronic, recurrent, congenital The prognosis for sternoclavicular injuries is generally favourable. In sprains or grade I injuries, the ligamentous structures are intact, and patients will make a full recovery in 1 to 2 weeks. In grade II injuries in which there was a traumatic or spontaneous subluxation, recovery takes longer. There is a possibility of cosmetic sequelae but typically not functional sequelae

Incidence of shoulder injury Shoulder injuries and sports-related shoulder pain are extensive burdens for athletes performing a shoulder loading sport, such as tennis, handball, volleyball, and swimming but also gymnastics, field hockey, or lacrosse. Shoulder injury rates depend upon many variables such as type of sports, sex, level of performance, and age but are reported to be between 18% and 61% in overhead throwing or smashing sports and up to 90% in elite swimmers How throwing sports cause shoulder problems The overhead throwing motion is a highly complex movement in which the individual body segments need to work together in a sequenced and coordinated way for an integrated functional movement, also referred to as the kinetic chain . Throwing is considered one of the fastest human motions performed, and maximum humeral internal rotation (IR) velocity reaches about 7000 to 7500°/s . Extreme amounts of external rotation (ER) in the range of 165° to 175° are achieved by the throwing extremity during the late cocking phase . Other sports, such as swimming, are characterised by an enormous amount of repetitive movements. Competitive athletes may swim 10 to 14 km a day, 6 or 7 days a week. This equates to 16 000 shoulder revolutions per week (2500 revolutions per day)

Return to play Limited evidence suggests that less than three in four athletes return to their previous level of sport participation after SLAP injury intervention. Despite the long ­history of the condition, SLAP injuries remain a prevalent problem in both overhead throwing athletes as well as contact athletes. After shoulder dislocations Return to play: The general understanding is that the patient must be pain free and have at least 90% of the range of motion and strength comparative to the uninjured side. This would normally take 2–3 weeks in conservatively treated patients RETURN TO PLAY SHOULDER AC shoulder joint separation - RTP after surgery 2 to 12 months , most common 6 months The shoulder has the GREATEST range of motion of any joint in the human body Return to play after arthroscopic repair 86% Three months after surgery for non contact vs 6 months contact sports Things to look out for : Pain free range of motion over 80% of strength compared to contralateral side was achieved. Internal ROM shoulder be LESS than 20 degrees Difference in total ROM should not be more than 10 degrees Regarding rotator cuff strength, in general, overhead athletes often exhibit sport-specific adaptations leading to a relative decrease in the strength of the external rotators and thus muscular imbalance in the rotator cuff