Background Atraumatic sternoclavicular joint (SCJ) instability is rare. Long-term outcomes are presented for patients managed with physiotherapy. A standardised method of assessment and treatment with a structured physiotherapy programme is also presented. Methods Long-term outcome was analysed in this prospectively collected series (2011-2019) of patients who were assigned to a structured physiotherapy programme for atraumatic SCJ instability. Outcome-measures (subjective SCJ grading of joint stability (SSGS score), Oxford shoulder instability score (OSIS adapted for SCJ) and visual analogue scale (VAS) for pain) were collected at discharge and long-term follow up. Results 26 patients (29 SCJ's) responded (return rate 81%). Mean follow-up was 5.1 years (range 0.9-8.3 years). 17/26 patients were hyperlax. 93% (27/29) of SCJs achieved a stable joint on SSGS score. Mean OSIS score at long-term follow up was 33.4 (range 3-48) and VAS 2.7 (range 0-9). 95% who were compliant with physiotherapy had a stable SCJ (mean OSIS 37.8 (SD 7.3) and VAS 1.6 (SD 2.1)). Those non-compliant, 90% were stable but had lower function (mean OSIS 25 (SD 14, p = 0.02) and more pain, VAS 4.9 (SD 2.9, p = 0.006). Conclusion The structured physiotherapy programme is highly effective in treating patients with atraumatic SCJ instability. Compliance was essential in ensuring better outcomes.

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We are delighted to bring you volume 55, issue 1 for the Journal of the Association of Chartered Physiotherapists in Respiratory Care. It was wonderful to see so many of the ACPRC community in person at our recent conference One team: meeting the challenge through people, practice and policy in April 2023, and the wide-variety of projects being presented. All abstracts accepted for poster or presentation at the conference will be published in a supplementary edition of the journal later this year. This volume starts with Buss et al. who present a service evaluation of a benchmarking project on mobilisation targets following oesophagectomy surgery. There are then two qualitative studies, with Hardy-Bosson et al. exploring perceptions and experiences of adults with neuromuscular disorders and their carers, in relation to airway clearance and respiratory physiotherapy in the community, and Jackson and Gardiner who explore the barriers and facilitators to physical activity, during the COVID-19 pandemic in people living with chronic respiratory disease. The experience from Leicester during the COVID-19 pandemic, in relation to upper-limb specialist input into intensive care, to prevent proning associated complications is then presented by Tunnicliffe et al. The volume also includes an updated position statement and considerations, from the 2021 publication by Gardiner et al. for remotely delivered pulmonary rehabilitation services. There is also a further publication from the ACPRC editorial board with Eden et al., presenting a scoping review on post-operative physiotherapy in people undergoing cardiac surgery. The final piece in the volume is an invited editorial from the outgoing chair of the editorial board Dr. Una Jones, in which she reflects on the work in the editorial board, since its inception in 2019, and the valuable resources and outputs that the board have produced. Many congratulations to Dr. Agnieszka Lewko, in being appointed new chair of the board. As always, we hope that you enjoy reading this issue of the ACPRC journal, and that you are inspired to write-up and submit your work. Please remember that we also provide members with support, through the research champion

Aims There remains a lack of consensus regarding the management of chronic anterior sternoclavicular joint (SCJ) instability. This study aimed to assess whether a standardized treatment algorithm (incorporating physiotherapy and surgery and based on the presence of trauma) could successfully guide management and reduce the number needing surgery. Methods Patients with chronic anterior SCJ instability managed between April 2007 and April 2019 with a standardized treatment algorithm were divided into non-traumatic (offered physiotherapy) and traumatic (offered surgery) groups and evaluated at discharge. Subsequently, midterm outcomes were assessed via a postal questionnaire with a subjective SCJ stability score, Oxford Shoulder Instability Score (OSIS, adapted for the SCJ), and pain visual analogue scale (VAS), with analysis on an intention-to-treat basis. Results A total of 47 patients (50 SCJs, three bilateral) responded for 75% return rate. Of these, 31 SCJs were treated with physiotherapy and 19 with surgery. Overall, 96% (48/50) achieved a stable SCJ, with 60% (30/50) achieving unrestricted function. In terms of outcomes, 82% (41/50) recorded good-to-excellent OSIS scores (84% (26/31) physiotherapy, 79% (15/19) surgery), and 76% (38/50) reported low pain VAS scores at final follow-up. Complications of the total surgical cohort included a 19% (5/27) revision rate, 11% (3/27) frozen shoulder, and 4% (1/27) scar sensitivity. Conclusion This is the largest midterm series reporting chronic anterior SCJ instability outcomes when managed according to a standardized treatment algorithm that emphasizes the importance of appropriate patient selection for either physiotherapy or surgery, based on a history of trauma. All but two patients achieved a stable SCJ, with stability maintained at a median of 70 months (11 to 116) for the physiotherapy group and 87 months (6 to 144) for the surgery group. Cite this article: Bone Jt Open 2022;3(10):815–825.

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