Proliance Surgeons
Grant H. Garcia, MD

Grant H. Garcia, MD Orthopedic Surgeon & Sports Medicine Specialist View Profile

Grant H. Garcia, MD

Grant H. Garcia, MD Orthopedic Surgeon & Sports Medicine Specialist View Doctor Profile

AC Joint Separation

AC Joint injury,shoulder separation , treatment - Everything You Need To Know - Dr. Nabil Ebraheim

Content from orthobullets.com

Background:

  • an acromioclavicular joint injury, otherwise known as a shoulder separation, is a traumatic injury to the acromioclavicular (AC) joint with disruption of the acromioclavicular ligaments and/or coracoclavicular (CC) ligaments
    • treatment is immobilization or surgical reconstruction depending on the degree of separation and ligament injury.
  • Epidemiology

  • incidence
    • common injury making up 9% of shoulder girdle injuries
  • demographics
    • more common in males and athletes
  • Pathophysiology

  • mechanism
    • direct blow to the shoulder
    • often sustained while falling onto the shoulder

Anatomy:

  • Stability
    • static
      • joint capsule
      • acromioclavicular (AC) ligaments
        • controls horizontal motion and anterior-posterior stability
        • has superior, inferior, anterior and posterior components
          • posterior and superior AC ligaments are most important for stability
      • coracoclavicular (CC) ligaments
        • controls vertical motion and superior-inferior stability
        • two ligaments
          • conoid
            • medial
            • inserts on clavicle 4.5cm medial to lateral edge
            • most important for vertical stability
          • trapezoid
            • lateral
            • inserts on clavicle 3cm medial to lateral edge
    • dynamic
      • anterior deltoid
      • trapezius

Presentation:

  • Symptoms
    • pain
      • usually over AC joint
      • can also be referred to the trapezius
  • AC Joint Reconstruction Surgery
  • Physical exam
    • lateral clavicle or AC joint tenderness
    • abnormal contour of the shoulder compared to contralateral side
    • stability assessment
      • horizontal (anterior-posterior) stability evaluates AC ligaments
        • cross-body adduction
        • horizontal instability (ISAKOS type 3B) may indicate need for more aggressive treatment
      • vertical (superior-inferior) stability evaluates CC ligaments

Treatment Options:

  • Nonoperative
    • brief sling immobilization, rest, ice, physical therapy
      • indications
        • type I and II
        • type III in most individuals
          • good results when clavicle displaced < 2cm
      • rehab
        • early shoulder range of motion
        • regain functional motion by 6 weeks
        • return to normal activity at 12 weeks
        • consider corticosteroid injections
      • outcomes
        • type III treated non-op had higher DASH scores at 6 weeks and 3 months, and equal function at 1 year with lower rate of secondary surgery (removal of hardware) compared to those treated operatively
      • complications
        • AC joint arthritis
        • chronic subluxation and instability

Operative

  • CC interval restoration (ORIF vs. Ligament Reconstruction)
    • indications
      • acute type IV, V or VI injuries
        • recent studies suggest no difference in functional outcomes between operative and nonoperative interventions for high grade injuries
      • acute type III injuries in laborers, elite athletes, patients with cosmetic concerns
      • chronic type III injuries that failed non-op treatment
        • historically it was thought acute injuries were treated with ORIF and chronic injuries were treated with CC ligment reconstruction
          • however, new studies have shown no difference in outcomes in types III injuries treated surgically after 6 weeks non-op treatment versus immediate surgery
    • contraindications
      • patient unlikely to comply with postoperative rehabilitation
      • skin problems over fixation approach site
    • techniques
      • ligament reconstruction with soft tissue graft
        • Modified Weaver-Dunn
          • distal clavicle excision with transfer of coracoacromial ligament to the distal clavicle to recreate CC ligament
        • autograft
        • allograft
      • fixation
        • suture
        • hook plate
        • CC screw (Bosworth)
        • cortical flip button (e.g Dog Bone)(+/- arthroscopic assistance)
        • K-wire
    • rehabilitation
      • sling immobilization for 6 weeks, no shoulder range of motion
      • return to full activity after 6 months

For more information visit orthobullets.com

  • Brown University
  • University of Pennsylvania
  • Cornell University
  • Hospital for Special Surgery
  • Rush University Medical Center
  • American Orthopaedic Society for Sports Medicine
  • American Academy of Orthopaedic Surgeons
  • American Association of Nurse Anesthetists