According to Mark Kaboly of the Pittsburgh Tribune-Review, Ben Roethlisberger has been diagnosed with a sternoclavicular joint sprain. Head coach Mike Tomlin shared the injury information earlier today.

Roethlisberger was driven to the ground by defenders Tamba Hali and Justin Houston in the third quarter of last night’s game against the Kansas City Chiefs. It appeared that the hit drove the quarterback’s elbow into the ground, injuring his right shoulder. He was taken to a local hospital last night for evaluation.

While speculation in social media and on television last night focused on a possible shoulder separation, Tomlin today revealed that the usually durable Roethlisberger in fact had sprained his sternoclavicular joint.

The sternoclavicular joint is the joint between the clavicle (collarbone) and sternum (breast bone). It is an uncommon injury when you consider all shoulder injuries. It typically occurs in contact and collision sports, such as football and rugby. It is a very painful, and potentially dangerous, injury, and sports medicine physicians who suspect athletes have suffered this injury take them very seriously.

The Dr. David Geier ShowBen Roethlisberger’s sternoclavicular and first rib injury: That’s Gotta Hurt segment from Episode 65 of The Dr. David Geier Show.

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The Steelers have not given more specific information on Roethlisberger other than to call the injury a sprain. Please understand that the following description of injuries to the sternoclavicular joint pertains to dislocations at this location and not specifically what he might or might not have specifically suffered.

Injuries to this joint usually involve a dislocation. Typically the athlete is injured with a direct blow, either to the chest or shoulder. Depending on the direction of the force, a blow to the shoulder can cause an anterior or posterior sternoclavicular dislocation. An anterior dislocation of this joint means that the collarbone has popped out in front of the sternum. A posterior dislocation means that the collarbone has gone behind the sternum. While both types of dislocations are very serious, a posterior dislocation can be a surgical emergency, as the end of the collarbone becomes extremely close to the airway and large blood vessels of the heart and chest.

Physical examination usually shows that the end of the collarbone is very prominent on the injured side if it is an anterior dislocation, and the athlete will be very tender at that location. Evaluation with x-rays, and a CT scan if needed, is critical, so we usually send players with suspected sternoclavicular dislocations to the emergency room right away.

Posterior sternoclavicular dislocation
Note the left clavicle (right side of image) dislocated behind the sternum on this CT scan. The end of the bone lies very close to the large blood vessels off the heart.

Treatment of these injuries depends on the direction of the dislocation. Anterior dislocations can be put back in place with gentle pressure on the clavicle, pushing it back in line with the sternum. Sometimes it’s difficult to reduce into the proper position, or it pops back out of place, but fortunately an anterior dislocation leaves only a cosmetic deformity. Usually little long-term functional deficit exists after the athlete has recovered.

A posterior dislocation, on the other hand, needs urgent reduction. Whether this reduction is done in the emergency room or the operating room is controversial. The clavicle needs to be reduced back into place with the sternum to prevent the clavicle from causing injury to the blood vessels and airway nearby. Occasionally surgery to open the joint and manually put the clavicle back into place is needed.

Hopefully Ben Roethlisberger’s injury is simply a sprain of that joint – essentially bruised with no dislocation of the collarbone in relation to the sternum. We should know much more about possible return to play as more information becomes available.

Note: The following post appeared in a modified form as an article for Bleacher Report.