HWN Suggests

Separation Anxiety

The most common mechanisms of injury are falls onto the shoulder directly, then the good old FOOSH (fall on outstretched hand). AC injuries can be suspected on exam if there is asymmetry at the location of the joint. In addition, point tenderness at the joint and pain on cross-arm adduction (bring the arm across the body) are both suggestive but not diagnostic. For that you’re going to need X-Rays...

Especially in fit patients, their overall muscle tone make make the inherent asymmetry caused by a tear of just one of these ligaments less obvious on conventional shoulder films. That is why you should get weighted films if you suspect an AC injury and your original X-Rays are inconclusive.…

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 Examining the Impact of AC Joint Injuries

AC joint injuries typically occur from a fall or a blow on the adducted arm. These injuries occur more commonly in young men during the first three decades of life, and frequently are associated with fall and winter sports, including football, skiing, snowboarding and ice hockey. AC joint injuries represent almost a third of all shoulder injuries in the National Football League (NFL) and are the most common upper extremity injury in ice hockey players.

Articles of Interest

Acromioclavicular Joint Dislocation

The injury is not a medical emergency, unless the clavicle is poking out through the skin or is associated with other major joint or bony fractures. An AC Joint can be treated any time, and in many cases, should be stabilised. When an ACJ is only mild (i.e. grade 1 or 2), then non operative management is usually successful. A grade 1 or 2 ACJ dislocation means that some of the ligaments are intact in the shoulder. This results in a very stable joint, despite the fact that some of the ligaments are strained or even ruptured..

Orthobullets - The treatment for type III

Type III AC injuries are those with complete rupture of the AC and coracoclavicular (CC) ligaments. Historically, nonoperative management of this type has yielded good results. It is currently debatable whether anatomical stabilization of AC joint dislocation benefits shoulder function. Stabilization techniques include CC screw fixation, coracoacromial ligament transfer, and myriad methods of CC ligament reconstruction.

AC Joint Separations: Overview of diagnosis and treatment

Separation of the acromioclavicular (AC) joint is a common injury encountered in the emergency department. Keys to optimal outcome and return of function in these patients include knowledge of injury mechanism, diagnosis and classification, and initial treatment.

Acromioclavicular (AC) Joint Injuries

Normal AC joint distance <5mm. Variation exists but with clinical suspicion any measurement >8mm is concerning for injury, comparison to normal contralateral side also useful.

Acromioclavicular (Shoulder) Separation

Usually, the patient will come in right away because it hurts even without movement (type I or type II tear), or he may come in days later without pain, having noted that the injured shoulder hangs lower or the clavicle rides higher (type III). There is a 5:1 male to female injury rate. Weight-bearing stress views are uncomfortable and unnecessary.

Acromioclavicular Joint Disorders

The acromioclavicular (AC) ligament and coracoclavicular (CC) ligaments are part of the static stabilisers of the joint. The AC ligament controls horizontal stability in the anterior­posterior plane whilst the CC ligaments serve to control vertical stability.

Acromioclavicular Joint Injury

Acromioclavicular joint subluxation and dislocation account for approximately 10% of all traumatic shoulder injuries. AC joint injury results from either direct or indirect injury to the shoulder. Direct injury to the joint occurs with a direct blow to the shoulder or, more commonly, when an individual falls with their arm in an adducted position.

Acromioclavicular Joint Lesions in Adolescents—A Systematic Review and Treatment Guidelines

'No impediment, small or great, would result from such an injury at the shoulder, only there will be a deformity at the shoulder'. Hippocrates believed this to be true centuries ago. These famous words by him, however, failed to stand the test of time. Various long-term complications of such injuries in children (such as duplication of the clavicle, chronic instability, cosmetic deformities and clavicle shortening) have been reported. Anatomists and orthopaedic surgeons have constantly debated and struggled to understand the complex pathoanatomy, biomechanics and management of acromioclavicular joint injuries for as long as medical interventions have existed. But the guidelines for the management of such injuries continue to be inconsistent and somewhat controversial.

Acromioclavicular joint separation

The AC joint is a synovial joint between an oval facet on the acromion and a similar facet on the distal end of the clavicle. Horizontal stability is provided by the AC joint while axial stability is provided by the CC joint. AC joint injuries account for about 9%-12% of shoulder girdle injuries, and the most common mechanism is direct trauma.

Grade 3 AC Joint Separation

A grade 3 AC joint separation is a true dislocation of the AC joint. While higher grade dislocations (grade 4, grade 5, and grade 6) are more severe they only differ from a grade 3 by the severity and the direction of the displacement. Unlike more minor sprains such as a grade 1 (no displacement) or grade 2 (minor displacement), a grade 3 injury is a disruption of not only the AC joint itself but also the important supporting ligaments, the coracoclavicular ligaments.

Orthopedic Sports Injuries: Off The Sidelines And Into The Emergency Department

ED management is conservative regardless of grade of injury. Minor injuries can be treated with sling immobilization, non-steroidal anti-inflammatory drugs SAIDs), ice, and relatively early mobilization. Grade III injuries require outpatient orthopedic referral and may benefit from operative intervention in selected cases.

Surgical versus conservative interventions for treating acromioclavicular dislocation of the shoulder in adults

Dislocation of the acromioclavicular joint is one of the most common shoulder injuries in a sport‐active population. The question of whether surgery should be used remains controversial. This is an update. There is low‐quality evidence that surgical treatment has no additional benefits in terms of function, return to former activities, and quality of life at one year compared with conservative treatment.

Two cases of shoulder pain

Type III injuries may require operative intervention for overhead laborers, elite athletes, or patients with greater than 20mm of CC space. Types IV to VI injuries are managed operatively with AC joint fixation or ligament reconstruction