 
 
Rehabilitation Protocol for Sternoclavicular Joint Reconstruction 
  
This protocol is intended to guide clinicians through the post-operative course for sternoclavicular joint reconstruction. 
This protocol is time based (dependent on tissue healing) as well as criterion based. Specific intervention should be 
based on the needs of the individual and should consider exam findings and clinical decision making. The timeframes for 
expected outcomes contained within this guideline may vary based on surgeon’s preference, additional procedures 
performed, and/or complications. If a clinician requires assistance in the progression of a post-operative patient, they 
should consult with the referring surgeon. 
  
The interventions included within this protocol are not intended to be an inclusive list of exercises. Therapeutic 
interventions should be included and modified based on the progress of the patient and under the discretion of the 
clinician.  
  
Considerations for the Post-operative sternoclavicular joint reconstruction 
Many different factors influence the post-operative rehabilitation outcome, including surgical technique (ie. tendon 
autograft harvest for repair), degree of SC joint instability, concomitant soft tissue or bone injury/repair, and individual 
patient factors including co-morbidities. It is recommended that patients meet all rehabilitation criteria in order to 
progress to the next phase and clinicians collaborate closely with the referring physician throughout the rehabilitation 
process.  
 
Post-operative Complications 
If you develop a fever, unresolving numbness/tingling, excessive drainage from the incision, uncontrolled pain or any 
other symptoms you have concerns about you should contact the referring physician.  
 
 
PHASE I: EARLY POST-OP (0-6 WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Reduce pain and swelling of the operative shoulder 
• Maintain elbow, wrist and hand AROM  
• Patient education  
Sling/precautions  
• Sling to be worn for 6 weeks (or as directed by surgeon) 
• Avoid PROM of the glenohumeral joint 
• Avoid scapular AROM (protraction, retraction, depression and elevation) as it may 
disrupt the repair and healing tissues  
• Avoid bearing weight through involved extremity  
• Avoid lifting any lifting with involved extremity  
• Avoid running and jumping due to impact forces upon landing that may aggravate healing 
tissues and bone  
Intervention 
• Cryotherapy as needed 
• AROM: cervical spine, elbow, wrist, hand 
• Hand gripping: ball squeeze 
• Cardiovascular exercise as tolerated: walking, stationary bike  
Criteria to 
Progress 
• Well controlled pain and swelling 
• Protect reconstruction site and autograft site (if applicable) 
• Maintain elbow, wrist and hand AROM 
 
 
 
 
 
 
 
 
PHASE II: INTERMEDIATE POST-OP (6-12WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Activation of muscles responsible for stabilizing the scapulothoracic and glenohumeral joint 
• Gradually restore PROM, AAROM of the GH joint at 6-8 weeks 
• Gradually restore AROM of the scapulothoracic joint and glenohumeral joint at 8 weeks 
• Wean from sling (if still wearing) 
• Begin shoulder and scapular strengthening at 8 weeks  
• Begin proprioception and neuromuscular control training 
• Identify and correct postural dysfunction as indicated  
Sling/precautions 
• Avoid repetitive overhead activities  
• No lifting > 5 pounds with involved extremity until 9 weeks post-op 
• Post-rehabilitation soreness should resolve within 12-24 hours  
Additional 
Interventions 
*Continue with 
Phase I 
interventions 
• AROM in all cardinal plane assessing scapular rhythm  
• Gentle glenohumeral mobilization as indicated  
 
Strengthening: 
• Rotator cuff strengthening in non-provocative positions (generally 0-45 degrees 
Scaption/abduction): scaption raises against gravity, Sidelying ER, lightly resisted ER/IR with 
theraband, isometrics  
• Scapular strengthening and dynamic neuromuscular control: low row, straight arm pulldowns, 
serratus punch, resisted T’s 
 
Stretching: 
Gentle corner or doorway pec stretch 
• Postural endurance exercises: scapular retractions, chin tucks  
• Walking, stationary bike, Stairmaster 
Criteria to 
Progress 
• Full AROM of the operative shoulder 
• Normal (5/5) strength for glenohumeral flexion/abduction/IR/ER degrees abduction  
 
PHASE III: LATE POST-OP AND GRADUAL RETURN TO SPORT(13+ WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Restore normal (5/5) rotator cuff strength at 90 degrees abduction including supraspinatus  
• Full multi-planar AROM with minimal to no substitution patterns  
• Advance proprioceptive and dynamic neuromuscular control training  
• Identify and correct postural dysfunction with sport/work specific tasks as indicated  
• Develop strength and control movements required for sport/work 
Sling/ 
precautions 
• Post-rehabilitation soreness should resolve within 12 hours  
• No lifting restrictions at ~4 months 
Additional 
Interventions 
*Continue with 
Phase I-II 
Interventions  
• Glenohumeral mobilizations as indicated 
• Multiplane AROM with gradual increase in velocity of movement  
 
Strengthening: 
• Rotator cuff strengthening at 45 degrees progressing to 90 degrees abduction and sport/work 
specific positions as well as other provocative positions: resisted IR/ER, elevation with ER, 
resisted scaption raises, facepulls/resisted W’s 
• Scapular strengthening and dynamic neuromuscular control in overhead or sport/work 
positions: prone or resisted I’s, T’s and Y’s, lower trap setting at wall, manual perturbations in 
varying degrees in elevation, serratus wall slides/roll ups, wall pushups, quadruped shoulder 
taps 
• Core strengthening 
 
Stretching: 
 
 
Corner or doorway pec stretch, Gentle posterior capsule stretch (across body) 
 
• Walking, stationary bike, Stairmaster, return to running/jumping as tolerated 
• Begin education in sport specific biomechanics with initial program for throwing, swimming, or 
overhead racquet sports 
Criteria to Return 
to Sport 
• Clearance from MD and ALL milestone criteria have been met 
• Maintains pain-free PROM and AROM 
• Performs all exercises demonstrating symmetric scapular mechanics 
• QuickDASH  
• PENN 
• For the recreational or competitive athlete, return-to-sport decision making should be 
individualized and based upon factors including level of demand on the upper extremity, contact 
vs non-contact sport, frequency of participation, etc. We encourage close discussion with the 
referring surgeon prior to advancing to a return-to-sport rehabilitation program. 
 
 
Contact 
Please email MGHSportsPhysicalTherapy@partners.org with questions specific to this protocol 
References: 
1. 
Logan C, Shahien A, Altintas B, Millett PJ. Rehabilitation following sternoclavicular joint reconstruction for persistent instability. International 
Journal of Sports Physical Therapy. 2018;13(4):752-762. doi:10.26603/ijspt20180752  
2. 
Petri, M., Greenspoon, J. A., Horan, M. P., Martetschläger, F., Warth, R. J., & Millett, P. J. (2016). Clinical outcomes after autograft reconstruction for 
sternoclavicular joint instability. Journal of Shoulder and Elbow Surgery, 25(3), 435–441. https://doi.org/10.1016/j.jse.2015.08.004  
3. 
Garcia JA, Arguello AM, Momaya AM, Ponce BA. Sternoclavicular Joint Instability: Symptoms, Diagnosis And Management. Orthop Res Rev. 2020 Jul 
28;12:75-87. doi: 10.2147/ORR.S170964. PMID: 32801951; PMCID: PMC7395708. 
 
 
