Acromioclavicular joint injury: Difference between revisions
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### Palpable posterior fullness or deformity despite significant swelling | ### Palpable posterior fullness or deformity despite significant swelling | ||
### SC dislocation may be appreciated | ### SC dislocation may be appreciated | ||
# Type 5 - | # Type 5 - Superior dislocation of the joint of 1-3x the normal spacing | ||
## CC ligament distance is increased 2-3x normal | ## CC ligament distance is increased 2-3x normal | ||
## Disruption of the deltotrapezial fascia | ## Disruption of the deltotrapezial fascia | ||
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# Type 6 - Complete dislocation with inf. displacement of distal clavicle into a subacromial or subcoracoid position | # Type 6 - Complete dislocation with inf. displacement of distal clavicle into a subacromial or subcoracoid position | ||
## Xray | ## Xray | ||
### Complete disruption of the AC and CC ligaments | ### Complete disruption of the AC and CC ligaments | ||
==Treatment== | ==Treatment== |
Revision as of 20:17, 30 March 2011
Background
Usually occurs from direct trauma to the adducted shoulder
Diagnosis
- Tenderness directly over AC joint, possibly with deformity
- Also palpate sternoclavicular joint, coracoclavicular ligaments for assoc injuries
- AC compression test
- Passively flex arm so is parallel with ground; then passively adduct across body
- Pain suggests AC joint injury
Imaging
- AP shoulder (highly consider comparison view)
- AC joint
- Normal width of AC joint in adults is 1-3mm
- By age 60 width is often less than 1mm
- Children and adolescents have a slightly wider joint space
- CC joint
- Normal distance is 11-13mm
- Comparison to opposite CC joint space is more important
- Increase in CC distance of 25-50% indicates complete CC ligament disruption
- Zanca view (AP w/ 10-15 degree cephalic tilt)
- Consider if AP view is ambiguous or injury is suspicious for type II AC injury or distal clavicle injury:
- Axillary view
- Obtain if coracoid tenderness is present to rule-out associated coracoid fx
- Helps to confirm ant-post position of clavicle in injury types III-IV
- AC joint
Classification
- Type 1 - AC ligament sprain; AC joint intact
- Exam
- Mild swelling, no deformity
- CC ligaments are nontender
- Only distal-most 1-2cm of clavicle is tender
- Active overhead and cross-body ROM are limited by pain
- Xray
- Often no abnormality is seen on xray; slight widening of the AC joint may occur
- Exam
- Type 2 - AC ligament torn and subluxed; coracoclavicular (CC) ligament may be partially torn but is intact
- Exam
- Prominent and tender AC joint w/ significant swelling
- Minimal tenderness of CC ligaments reflecting lack of significant injury
- There may be instability of the distal clavicle in the horizontal plane
- Xray
- Partial elevation of the distal clavicle w/ no or minimal widening of the CC distance
- Exam
- Type 3 - AC and CC ligaments torn; complete dislocation of the joint
- Exam
- Deformity of the AC joint is clearly visible
- Marked tenderness of the CC ligaments (helps distinguish Type 3 from type 2)
- Xray
- Elevated distal clavicle and increased CC distance
- Distal clavicle is positioned above the plane of the top of the acromion
- Exam
- Type 4 - Complete dislocation with posterior displacement of distal clavicle into or through the trapezius
- Exam
- Palpable posterior fullness or deformity despite significant swelling
- SC dislocation may be appreciated
- Exam
- Type 5 - Superior dislocation of the joint of 1-3x the normal spacing
- CC ligament distance is increased 2-3x normal
- Disruption of the deltotrapezial fascia
- Exam
- Shoulder appears to droop
- Severe superior displacement of the clavicle, which may cause tenting, ischemia of skin
- Clavicle is perhced above the muscle and does not reduce when the pt shrugs shoulder
- Xray
- Clavicle is elevated above acromion approximately 1-3x width of the clavicle
- CC distance is increased two to three times the normal range
- Type 6 - Complete dislocation with inf. displacement of distal clavicle into a subacromial or subcoracoid position
- Xray
- Complete disruption of the AC and CC ligaments
- Xray
Treatment
- Type 1
- Rest, ice, protection with a sling
- ROM and strengthening exercises indicated as soon as tolerated
- Return to sport or work is limited only by pain
- Type 2
- Rest, ice, 3-7 days of immobilization in a sling
- ROM and strenghtnening exercises as soon as tolerated
- Return to sport or work once full ROM and strength are regained
- Type 3
- Rest ice, 2-3 weeks of immobilization in a sling
- ROM and strengthening exercises indicated as soon as tolerated
- Return to sport or work 6-12 weeks following injury
- Ortho consultation within 1 week
- Type 4-6
- Require orthopedic evaluation; emergent if neurovascular compromise exists
Source
UpToDate