Acromioclavicular joint injury: Difference between revisions
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| align="center" style="background:#f0f0f0;"|'''Image''' | | align="center" style="background:#f0f0f0;"|'''Image''' | ||
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| '''Type | | '''Type I'''|| | ||
*AC ligament sprain | *AC ligament sprain | ||
*AC joint intact | *AC joint intact | ||
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[[File:Classification type 1 of AC separation.png|120px]] | [[File:Classification type 1 of AC separation.png|120px]] | ||
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| '''Type | | '''Type II''' | ||
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*AC ligament torn | *AC ligament torn | ||
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[[File:Classification type 2 of AC separation.png|120px]] | [[File:Classification type 2 of AC separation.png|120px]] | ||
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| '''Type | | '''Type III'''|| | ||
*AC and CC ligaments torn | *AC and CC ligaments torn | ||
*Complete dislocation of the joint | *Complete dislocation of the joint | ||
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[[File:Classification type 2 of AC separation.png|120px]] | [[File:Classification type 2 of AC separation.png|120px]] | ||
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| '''Type | | '''Type IV'''|| | ||
*Complete dislocation with posterior displacement of distal clavicle in/through trapezius | *Complete dislocation with posterior displacement of distal clavicle in/through trapezius | ||
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[[File:Classification type 4 of AC separation.png|120px]] | [[File:Classification type 4 of AC separation.png|120px]] | ||
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| '''Type | | '''Type V''' | ||
|| | || | ||
*More severe form of type III injury | *More severe form of type III injury | ||
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[[File:Classification type 5 of AC separation.png|120px]] | [[File:Classification type 5 of AC separation.png|120px]] | ||
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| '''Type | | '''Type VI''' | ||
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*Complete dislocation with clavicle displaced inferiorly | *Complete dislocation with clavicle displaced inferiorly | ||
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==Management== | ==Management== | ||
===Type | ===Type I=== | ||
*Rest, ice, [[sling]] | *Rest, ice, [[sling]] | ||
*ROM and strengthening exercises as soon as tolerated | *ROM and strengthening exercises as soon as tolerated | ||
*Return to sport or work is limited only by pain | *Return to sport or work is limited only by pain | ||
===Type | ===Type II=== | ||
*Rest, ice, [[sling]] x 3-7 days | *Rest, ice, [[sling]] x 3-7 days | ||
*ROM and strenghtnening exercises as soon as tolerated | *ROM and strenghtnening exercises as soon as tolerated | ||
*Return to sport or work once full ROM and strength are regained | *Return to sport or work once full ROM and strength are regained | ||
===Type | ===Type III=== | ||
*Rest, ice, [[sling]] x2-3 weeks | *Rest, ice, [[sling]] x2-3 weeks | ||
*ROM and strengthening exercises as soon as tolerated | *ROM and strengthening exercises as soon as tolerated | ||
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*Ortho consultation within 1 week | *Ortho consultation within 1 week | ||
===Types | ===Types IV-VI=== | ||
*Require orthopedic evaluation; emergent if neurovascular compromise exists | *Require orthopedic evaluation; emergent if neurovascular compromise exists | ||
*Generally operative | *Generally operative |
Revision as of 22:02, 13 June 2020
Background
- Occurs via direct trauma to the adducted shoulder
- Acromioclavicular (AC) and coracoclavicular (CC) ligaments may be affected
- Routine use of stress radiographs is controversial (low yield)
Clinical Features
- Tenderness directly over AC joint (with possible deformity)
- AC compression test
- Passively flex arm so It is parallel with ground; then passively adduct across body
- Pain suggests AC joint injury
- Passively flex arm so It is parallel with ground; then passively adduct across body
- Ability to touch contralateral shoulder with injured arm suggests lack of shoulder dislocation
Differential Diagnosis
Shoulder and Upper Arm Diagnoses
Traumatic/Acute:
- Shoulder Dislocation
- Clavicle fracture
- Humerus fracture
- Scapula fracture
- Acromioclavicular joint injury
- Glenohumeral instability
- Rotator cuff tear
- Biceps tendon rupture
- Triceps tendon rupture
- Septic joint
Nontraumatic/Chronic:
- Rotator cuff tear
- Impingement syndrome
- Calcific tendinitis
- Adhesive capsulitis
- Biceps tendinitis
- Subacromial bursitis
- Cervical radiculopathy
Refered pain & non-orthopedic causes:
- Referred pain from
- Neck
- Diaphragm (e.g. gallbladder disease)
- Brachial plexus injury
- Axillary artery thrombosis
- Thoracic outlet syndrome
- Subclavian steal syndrome
- Pancoast tumor
- Myocardial infarction
- Pneumonia
- Pulmonary embolism
Evaluation
Workup
- 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 with 10-15 degree cephalic tilt)
- Consider if AP view is ambiguous, concern for type II injury or distal clavicle injury
- Axillary view
- Obtain if coracoid tenderness is present to rule-out associated coracoid fracture
- Helps to confirm ant-post position of clavicle in injury types III-IV
- AC joint
Diagnosis
Classification | Anatomic Injury | Exam | X-ray | Image |
Type I |
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Type II |
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Type III |
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Type IV |
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Type V |
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Type VI |
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Management
Type I
- Rest, ice, sling
- ROM and strengthening exercises as soon as tolerated
- Return to sport or work is limited only by pain
Type II
- Rest, ice, sling x 3-7 days
- ROM and strenghtnening exercises as soon as tolerated
- Return to sport or work once full ROM and strength are regained
Type III
- Rest, ice, sling x2-3 weeks
- ROM and strengthening exercises as soon as tolerated
- Return to sport or work 6-12 weeks following injury
- Ortho consultation within 1 week
Types IV-VI
- Require orthopedic evaluation; emergent if neurovascular compromise exists
- Generally operative
Disposition
- Generally outpatient, unless neurovascular compromise