Sternoclavicular instability is rare but occurs frequently enough that a shoulder surgeon will expect to encounter it several times during a career, and more if one has significant exposure to high-energy trauma. The results of treatment of patients with sternoclavicular instability are generally good if treatment is chosen appropriately and indicated surgeries are carried out with care. This article reviews the natural history of the various forms of sternoclavicular instability and the indications for surgery, the anatomy of the region, surgical technique, and complications. Avoiding inappropriate patient selection, preventing hardware-related complications, and preserving or reconstructing the rhomboid ligament are emphasized. Although this region can be somewhat intimidating because of the surrounding anatomic structures, a knowledgeable and careful surgeon can manage this joint instability safely and reliably produce good results.
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