INJURIES OF THE ACROMIOCLAVICULAR JOINT – Phyisoscare

INJURIES OF THE ACROMIOCLAVICULAR JOINT
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INJURIES OF THE ACROMIOCLAVICULAR JOINT

Acromioclavicular joint may be a diarthrodial joint with fibrocartilaginous disk between the 2 bones (similar to a meniscus). Two types of AC injuries are described.
ACROMIOCLAVICULAR JOINT- by www.physioscare.com
ACROMIOCLAVICULAR JOINT


THE ACROMIOCLAVICULAR JOINT SPEAKS 

  • I’m essentially a plane joint.
  • I permit gliding rotation between the clavicle and therefore the scapula.
  • My structural integrity depends on the intrinsic capsular element, the superior acromioclavicular ligament and therefore the extrinsic coracoclavicular ligament, which forms a hood over the interval between the coracoid process and the acromion.

Incidence is 12 percent and is common within the young. Male: Female ratio is 5:1.

Do you know?
• The common name for ACL injury is shoulder separation.
• ACL injuries are 4 to 5 times more common than sternoclavicular injuries.

Mechanism of Injury 

  • Direct force is the most common mechanism of injury as in RTA, assault, athletic events like the tackling, etc.
  • Indirect force is due to fall on the outstretched hands.
  • Downward indirect force through the upper extremity is relatively rare.

Clinical Features 
Here, the patient complains of pain, swelling, & difficulty in raising the arm up. The patient supports the affected shoulder by holding the elbow with opposite hand. On examination, there’s tenderness and therefore the lateral end of clavicle is prominently felt.

Ac clinical photograph X-ray images- by www.physioscare.com
Ac clinical photograph X-ray images

Classification (Sage and Salvatore’s) 

Based on injuries to acromioclavicular and coracoclavicular ligaments.
Type I: Minor sprain to acromioclavicular ligaments.
Type II: Rupture of ACL, sprain of CCL.
Type III: Both ACL & CCL ruptured, clavicle is displaced upwards.
Type IV: Same as the type III, but with upward and posterior displacement of clavicle.
Type V: Type III with severe displacement of clavicle towards the base of the neck.
Type VI: Inferior dislocation with clavicle towards base of the neck.

Radiographs 
The following views are required:
• AP view with 15° cephalic tilt to prevent overlap of the spine of scapula on routine AP views.
• Lateral view—axillary view of the shoulder.
• Stress radiographs—to differentiate from type II and type III by suspending a weight of 10 to 15 lbs around the wrist.

Management
Type I: Rest, ice bags, NSAIDs, etc.
Type II: Sling for 10 to 14 days, adhesive strapping, elastic strapping, cast or harness. Surgery is required for persisting pain.
Type III: Here, Conservative methods like reduction & retention with sling and harness.

Surgical methods include :

• Acromioclavicular repair.
• Coracoclavicular repair.
• Excision of distal end of clavicle for old symptomatic cases.
• Dynamic muscle are transfer by transferring the coracoid process.
Types IV, V & VI: Here, Require open reduction, internal fixation, repair and reconstruction.

Complications

• Associated fracture clavicle.
• Coracoclavicular ossification.
• Osteolysis of distal clavicle.
• Complications after surgery like infection, etc.
• Complications after non-operative treatment like joint stiffness, periarthritis, etc.

Delayed complications: These include:

• Step-like deformity.
• ACM joint arthritis.
• Pain during weightlifting.


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