Sternoclavicular Joint Palpation Pain: The Shoulder’s Waddell Sign?

Journal of Shoulder and Elbow Surgery, May 17th, 2018

Ponce, MD Et. Al, The University of Alabama at Burlington

We’ve got an expensive problem with pain. America’s tab runs approximately $100 billion a year in pain-related medical expenses.  Thankfully, understanding and incorporating pain science in practice has become more widespread in recent years, much in part due to educators such as Adriaan Louwe, Lorimer Moseley, and many more.

When dealing with pain in the clinic, it’s often helpful to understand the difference in contribution between organic pain (think anatomical and tissue-damage related) and non-organic pain (pain stemming from areas unrelated to tissue damage, central sensitization…). The authors of this study wanted to explore the relationship between results of a shoulder examination test (palpating the sternoclavicular joint) and psychosocial conditions (anxiety, depression, chronic pain…) to help determine the presence of nonorganic pain in the shoulder, similar to Waddell’s Signs.

What Happened When 132 Sternoclavicular Joints Were Palpated?

The study enrolled 132 subjects without a history of pain or trauma to their SC joints. The authors further excluded other sources of possible organic pain, such as rheumatoid arthritis, or areas related to SC joint pain. Subjects then filled out the QuickDash, SPADI, PHQ-2, Pain self Efficacy Questionaire (PSEQ) and the Pain Catastrophizing Scale (PCS). After palpating each of the subject’s SC joints, we found out that:

• 26 of the 132 had tenderness to palpation in the SC Joint (18 women, 8 men)
• The tender group had:
  • Significantly higher average outcome measures compared to the non-tender group
  • A strong association with higher levels of subjective physical disability and psychosocial distress
  • A higher presence of chronic pain and mental health disorders with the following “relative risk ratios” (i.e. how much more likely someone is to have the condition):
    • Depression: 4.53x
    • Anxiety: 3.67x
    • Any Other Mental Illness: 2.36x
    • Chronic Pain: 1.96x

How Does Understanding Non-Organic Pain Help My Practice?

Having tenderness at the SC joint with palpation doesn’t immediately diagnose a patient with having psychosocial origins of pain; however, with further studies validating this sign, could help confirm or reject your suspicions of non-organic sources of pain. The authors discuss different reasons why having a better understanding and recognition of non-organic pain could help your management of pain:

• Aids with prognosis: For example, because the pain is not organic, recovery may not necessarily follow traditional tissue healing timelines
• Helps determine candidates for orthopedic procedures: Operating on a patient to fix a non-organic source of pain could result in increased spending and hardship for the patient
• Facilitates appropriate interventions: If you know there could be components of anxiety, depression, chronic pain e.t.c. then you could consider utilizing an interdisciplinary and multi-modal approach to attain the best patient outcome

It’s important to consider pain in a multi-faced approach. This study could help us better understand and explore instances when non-organic, psychosocial pain could be playing a role.

Tyler Cope

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