the acromioclavicular joint is the point where the clavicle meets the scapula.
the process extending from the scapula where it meets the clavicle is known as the acromion .
another bony process located below the clavicle is called the coracoid.
the acromioclavicular ligament connects the collarbone to the the acromion process.
the coracoacromial ligament attaches the coracoid to the acromion.
the coracoclavicular ligament connects the collarbone to the coracoid.
it consists of two ligaments: the trapezoid ligament in front and the conoid ligament behind .
the acromioclavicular joint plays an important role in shoulder movement.
acromioclavicular joint dislocation is a traumatic injury to the joint with disruption of the acromioclavicular ligaments and /or coracoclavicular ligaments .
so that the acromion begins to move away from the clavicle.
an acromioclavicular joint injury often occurs as a result of a direct blow from a fall onto the shoulder or on outstretched arm.
athletes who play contact sports such as football and hockey are susceptible to this injury .
symptoms .
symptoms may include pain and weakness in your
shoulder.
you may not be able to move your shoulder.
tenderness over the acromioclavicular joint when touched on top of the shoulder.
your shifted clavicle may create a visible bump beneath your skin .
plain radiographs (x-ray ) confirms the diagnosis
of acromioclavicular joint dislocation.
common findings include misalignment of the joint which indicates an acromioclavicular dislocation.
sometimes a stress view is helpful.
it is the x-ray is taken while the injured
person holds a weight to accentuate the separation.
stress views may be helpful to evaluate type 3 injuries if surgery is being considered or if an ac separation is suspected but not visible on the initial x-rays.
classification:
the position of the clavicle and the amount of separation are used to grade the severity of the injury.
type 1 acromioclavicular injuries occur when the acromioclavicular ligament is stretched and partially torn .
the acromioclavicular joint remains stable.
type 2 acromioclavicular injuries occur when the acromioclavicular ligament is completely torn and the elevation of the clavicle is more evident on x-rays.
type 3 acromioclavicular injuries occur when the acromioclavicular ligament and coracoclavicular ligaments are completely torn .
the clavicle is 100% displaced from the acromion.
type 4 acromioclavicular injuries occur when the ligaments are completely torn and the clavicle is pushed backwards into the trapezius muscle.
type 5 acromioclavicular injuries occur when the ligaments that stabilize the acromioclavicular joint are completely torn and the deltoid and trapezius muscles are torn away from the clavicle .
type 6 acromioclavicular injuries occur when the ligaments and muscles that stabilize the acromioclavicular joint are torn and the clavicle is dislocated inferiorly and lodged underneath the coracoid.
treatment:
most grade 1 to 3 acromioclavicular separations are treated successfully with non-operative treatment that may include:
painkillers and anti-inflammatory medications.
ice to reduce pain and swelling.
rest in a protective sling until pain subsides ,about one to two weeks.
a rehabilitation program and physiotherapy to restore normal motion and strength is begun as soon as tolerated.
the patient is allowed to return to sports after about two weeks for a grade one injury .
six weeks for a grade two injury.
and up to twelve weeks for a grade three injury.
operative treatment.
surgery may be necessary for:
acute type 4 ,5 or 6 injuries.
acute type 3 injuries in laborers and athletes.
chronic type 3 injuries that does not respond well to non-operative treatment.
a variety of surgical methods have been used to
stabilize a separated acromioclavicular joint.
the acromioclavicular joint can be adequately stabilized with acromioclavicular hook plate fixation.
or by coracoclavicular ligament reconstruction.
the acromioclavicular joint can be fixed by k -wires.
or with Coracoclavicular screw fixation.
post surgery rehabilitation.
recovery programs following surgical repair vary depending on the type of surgery performed.
general post-operation care recommendations include:
the use of a sling is required for about four weeks.
after the removal of the sling six to eight weeks of physical therapy is necessary to regain full motion .
you can drive your car from six to eight weeks.
significant lifting and swimming from three months.
throwing in contact sports may be delayed for four to six months.
full recovery after acromioclavicular joint surgery takes
6 to 12 months.
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9 сен 2024
