Ben Roethlisberger's newest injury has the media and fans speculating about the 6-3 Steelers' prospects of maintaining the momentum of their four-game winning streak. Reportedly nursing a sternoclavicular (SC) joint separation and, according to today's TV updates, a rib injury, much mystery remains regarding the severity of Big Ben's condition.
The SC Joint
The SC joint, where the collarbone meets the sternum (breastbone) (see diagram), provides the connection between the shoulder girdle and the trunk. Though it permits only limited movement, the SC joint is involved in most movements that occur at the shoulder.
If you place your fingers at your SC joint and then elevate or depress your shoulder, you will feel the movement that takes place there and understand the importance of stability in this region. This is also the case if you move your shoulder backward or forward, or move your arm in a circular motion.
What is an SC Joint Separation?
A separation of the SC joint implies that the ligaments connecting the two bones have been badly sprained. This is why you may have seen some reports referring to Roethlisberger's injury as a sprain and others as a separation. Sprains are graded between 1 and 3, with a Grade 3 being complete tears of the involved ligaments. The SC joint may be partially out of alignment after a sprain (referred to as a subluxation), or the clavicle may dislocate completely. In the case of trauma, dislocation is more likely, while subluxations are known to occur spontaneously, generally in a younger population, particularly in the presence of ligamentous laxity (looseness of the ligaments).
SC joint dislocations occur anteriorly (forward) far more often than posteriorly (backward), and in some instances requires surgery in order to reposition the clavicle. The integrity of the ligament connecting the clavicle (collarbone) to the first rib is paramount to preserving the stability of the region. Oftentimes the SC joint remains prominent after healing and, though this is not significant of outcome, some do report long-term pain or loss of function after SC dislocation.
Mike Baxter of the NY Mets suffered a SC separation, displacement of his clavicle and torn rib cartilage when he hit the outfield wall to save Johan Santana's no-hitter in early June. You may recall that it was two months before he re-joined the team. That recovery time is fairly typical.
As I've written before, predictions for return to competition after injuries in the pro ranks are generally unrealistically optimistic. Roethlisberger has somehow often been an exception to that rule. He has seemed to rebound more quickly than expected, in part because he appears to play (though sometimes less effectively), while still in the throes of injury. Perhaps he is also a fast healer.
Reports that say Roethlisberger is likely to start in week 12 are being generous. This is a pretty serious injury to his throwing shoulder and if his rib injury is anything but very mild, it too is likely to get in his way. Both injuries require rest to heal and the shoulder should be rehabbed to restore the strength, mobility and power that may have been lost during the early post-injury recovery. But, then again, we're talking about Big Ben...