Acromioclavicular Joint (AC) |
 AC Injuries
Acromioclavicular separations or sprains
can vary in severity, depending on the extent of injury to
the stabilizing ligaments and capsule. Depending on the severity
of the blow causing the injury, most of the time only a partial
tear of the acromioclavicular ligament will occur.
If this is the case then only a first-
degree injury is produced. A second-degree injury occurs when
the acromioclavicular ligament is completely tom, but the coracoclavicular
ligament remains intact. This can also include subluxation
or partial displacement.
The subluxation isn't always noticeable
upon examination, but can be confirmed on x-ray. If the force
is enough than it tears the acromioclavicular ligament, the
coraclavicular ligament, and the capsule, it is known as a
third-degree injury. A third degree injury is obvious on examination,
and can be confirmed on x-ray.
Who
Athletes are the most likely candidates
for AC injuries, more specifically football players and hockey
players. These being the sports that usually put lots of stress
on the shoulders in general. An athlete who has an AC injury
will often leave the field/ice holding his/her arm close to
the side.
It's very important to find out the exact
happenings of the injury, that is did the athlete fall on the
outstretched arm, or receive a severe blow to the arm (Acromial
area). It is important when examining the area to rule out
pain from the contusion by manipulating the clavicle at midshaft.
Sometimes there's an obvious deformity or easily detected motion
at the AC joint which makes it easier to diagnose the injury.
The more difficult to diagnose is the less severe injury. Often
times the athlete will be put through a variety of motion tests
to get the proper diagnosis promptly.
Management
Treatment of these injuries depends on
the severity, first and second degree sprains of the AC joint
can often be treated successfully with a sling for 2 to 4 weeks,
when pain is alleviated. This is usually followed up with some
physical therapy to restore normal range of motion and to strengthen
the upper extremities. The treatment of third-degree sprains
of complete dislocations varies.
Some doctors think it best to be aggressive
and perform an open reduction (surgery). Other doctors feel
that they should be treated non- surgically because people
tend to do well and can function with complete dislocations.
When surgery is performed, it is usually directed at reconstruction
of the conoid and trapezoid ligaments (coraclavicular ligaments).
Return to Activity
It is important that the athlete not
return to sport until they have full range
of nonpainful motion, no tenderness upon direct
palpation of the acromioclavicular joint, and
no pain when manual traction is applied.
Prognosis
The prognosis of these injuries is very
good, obviously better for the lower grade injuries (first
and second degree). However, even third degree injuries will
do well if the appropriate treatment is applied and enough
rehabilitation and rest is allowed.
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