Bearn, J Anat 1967 - Direct Observations on the Function of the Capsule of the Sternoclavicular Joint in Clavicular Support

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Direct Observations on the Function of the Capsule of the Sternoclavicular Joint in Clavicular Support

Bearn·J Anat·1967·138 citations·Biomechanical study

Free Full Text·PubMed

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This 1967 cadaveric study by Bearn investigated which structures of the sternoclavicular joint maintain clavicular position when the arm hangs at rest. Using 5 post-mortem specimens, each ligament was sequentially cut under graded loading to determine its contribution to clavicular support. The study directly addressed why trapezius EMG activity disappears when the shoulder is fully dependent.

Key Findings

The SCJ capsule is the essential stabilizer of clavicular poise. Cutting the costoclavicular ligament, interclavicular ligament, or disc — alone or in any combination. Produced no measurable change in clavicular position under loads up to 20 lb.
Cutting the capsule alone was catastrophic: the lateral clavicle dropped ~1 inch below the medial end under gravity alone. Adding less than 5 lb then tore the disc from the costal cartilage.
At 10 lb loading (approximate weight of the upper limb), the intact capsule arrested descent after 1.0–1.5 inches. Each additional 5 lb (up to 20 lb) produced only 0.1 inch further drop. The capsule stiffens progressively under load.
The capsule ruptured at 30–40 lb, always by avulsion of the posterior-superior portion from the sternum with a bony flake. The anterior capsule is thinner. This explains why SCJ dislocations are almost always anterior, not posterior.
In 78% of 50 male subjects, the interclavicular ligament was palpable under tension in full shoulder depression, confirming in vivo that the SCJ capsule is loaded in the dependent position.

Board PearlThe SCJ capsule — not the trapezius or costoclavicular ligament — is the primary passive stabilizer of the clavicle in the dependent shoulder.

Direct Observations on the Function of the Capsule of the Sternoclavicular Joint in Clavicular Support.

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|

Direct Observations on the Function of the Capsule of the Sternoclavicular Joint in Clavicular Support

Bearn·J Anat·1967·138 citations·Biomechanical study

Free Full Text·PubMed

|

This 1967 cadaveric study by Bearn investigated which structures of the sternoclavicular joint maintain clavicular position when the arm hangs at rest. Using 5 post-mortem specimens, each ligament was sequentially cut under graded loading to determine its contribution to clavicular support. The study directly addressed why trapezius EMG activity disappears when the shoulder is fully dependent.

Key Findings

The SCJ capsule is the essential stabilizer of clavicular poise. Cutting the costoclavicular ligament, interclavicular ligament, or disc — alone or in any combination. Produced no measurable change in clavicular position under loads up to 20 lb.
Cutting the capsule alone was catastrophic: the lateral clavicle dropped ~1 inch below the medial end under gravity alone. Adding less than 5 lb then tore the disc from the costal cartilage.
At 10 lb loading (approximate weight of the upper limb), the intact capsule arrested descent after 1.0–1.5 inches. Each additional 5 lb (up to 20 lb) produced only 0.1 inch further drop. The capsule stiffens progressively under load.
The capsule ruptured at 30–40 lb, always by avulsion of the posterior-superior portion from the sternum with a bony flake. The anterior capsule is thinner. This explains why SCJ dislocations are almost always anterior, not posterior.
In 78% of 50 male subjects, the interclavicular ligament was palpable under tension in full shoulder depression, confirming in vivo that the SCJ capsule is loaded in the dependent position.

Board PearlThe SCJ capsule — not the trapezius or costoclavicular ligament — is the primary passive stabilizer of the clavicle in the dependent shoulder.

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