A thorough history, physical examination, and imaging evaluation are critical to establish the correct diagnosis, guide treatment, and ensure optimal outcomes. Acromioclavicular joint acj injuries are very common sporting injuries. Depending on its severity, the injury is associated with rupture of the acromioclavicular and coracoclavicular ligaments. Ac joint injuries represent nearly half of all athletic shoulder injuries, often resulting from a fall on to the tip of the shoulder with the arm in adduction, or a direct blow to the acromion with the humerus adducted, as in collision in highimpact contact sports. There are several methods for treatment of acromioclavicular luxation and distal clavicular fracture. It is also sometimes called the patellar tendon as it is a continuation of the quadriceps tendon. Imaging can be used to classify acromioclavicular injuries, with the rockwood system most commonly used to. Range of motion exercises with or without weights are very helpful in reducing pain and are discussed in this article. Shamus, pt, cscs t he shoulder is a complex anatomical structure that is comprised of several joints that permit a great deal of. Injury may occur as a consequence of throwing sports or chronic. Acromioclavicular dislocation acd is a common injury. Whereas clinical studies justify the medical use, risks and benefits remain unclear. The coracoclavicular ligaments conoid and trapezoid ligament are major stabilizing components that prevent superior dislocation of the clavicle. Acromioclavicular dislocation can be treated using several surgical techniques.
Type ii lesions are characterised by a complete rupture of the ac ligaments and a strain of the cc ligaments resulting in a displacement of the end of the clavicle of acromioclavicular joint dislocation occurs as a result of an acute traumatic event. Application of principal components analysis and gaussian mixture models to a popular choice is the gaussian mixture model where each printer can be rep resented by a gaussian distribution. The superior acromioclavicular ligament blends anteriorly and posteriorly with the aponeuroses of these muscles, respectively, and when present is in contact with the articular disk, 10, 11. Acromioclavicular joint pain 2 acromioclavicular joint clavicle coracoclavicular ligaments acromion coracoacromonial ligament humerus biceps muscle scapula introduction healthshare is committed to improving your health and wellbeing.
This study was based on the data acquired from the analysis of 28 patients with ac luxation surgically treated in the clinical center of montenegro. Acromioclavicular ac joint injection what is an ac joint injection. Acromioclavicular joint injuries and, more specifically, separations are commonplace both in general practice and during athletic participation. The strong accessory coracoclavicular ligament is the main stabilizer of the acj, particularly at large degrees of separation, 9. The first studies on acromioclavicular ac luxation repair were by hippocrates, galen, and paul of aegina. A joint dislocation can cause damage to the surrounding ligaments, tendons, muscles, and nerves. Acromioclavicular joint pain or ac joint pain is a common issue that occurs in many people, especially those with active lifestyles. The acromioclavicular ligament, which attaches the clavicle to the acromion of the scapula superior acromioclavicular ligament this ligament is a quadrilateral band, covering the superior part of the articulation, and extending between the upper part of the lateral end of the clavicle and the adjoining part of the upper. According to tossy et al 5 and allman, 6 type i lesions show a wellaligned joint with strained ligaments. A taping technique for the treatment of cromiocavicuar joint sprains. Acromioclavicular ac joint injuries are common in athletic populations and account for 40% to 50% of shoulder injuries in many contact sports, including lacrosse, hockey, rugby and football. Listen to the audio pronunciation in the cambridge english dictionary. Case reports in medicine hindawi publishing corporation. Others, such as those between the vertebrae, are gliding.
At the level of the pons, the sensory nuclei merge to form a. A shoulder separation is a fairly common injury, especially in certain sports. Repair of complete acromioclavicular separations using the acromioclavicular hook plate. Oct 22, 2018 acromioclavicular joint injuries are often seen after bicycle wrecks, contact sports, and car accidents. Of, relating to, or affecting both the scapula and the clavicle. In order to overcome recurrent dislocation after revision surgery, a reconstruction of the conoid and trapezoid. Acromioclavicular ac joint injuries account for nearly half of all shoulder injuries among athletes involved in contact sports. The injury actually involves the acromioclavicular ac joint. Acromioclavicular ac joint injuries are more common than sternoclavicular sc joint injuries. The management of ac lesions is based on minimal intervention, either surgical or nonsurgical, 9 aiming to restore both vertical and horizontal stability 10 and a stable joint. However, pediatric acromioclavicular injuries have also increased owing to the rising popularity of dangerous summer and winter sporting activities.
The acromioclavicular joint, or ac joint, is one of four joints that compride the shoulder complex. Clinical comparison of two types of hook plate in surgical. Acromioclavicular joint disruption mechanism of injury. Is acromioclavicular joint pain your biggest problem. The majority of ac joint injuries are successfully treated nonoperatively with a period of sling immobilisation followed by progressive physical therapy and shoulder range of motion. Dislocation of the acromioclavicular joint is a common joint injury in sport, especially those in which there is the risk of falling on to the point of the shoulder. This information leaflet is produced by health professionals who are expert in improving musculoskeletal. Tightrope fixation of complex acromioclavicular separation. Lubricated by the subacromial bursa, the subacromial space in health is narrow, and the anatomical structures surrounding it are responsible for maintaining static and dynamic shoulder stability. Treatment options for acromioclavicular joint separation. Operative treatment of acromioclavicular joint injuries is recommended for higher degree dislocations.
The diagnosis and treatment of acute dislocation of the. The most common presentation was for chronic pathology. The acromioclavicular joint is located at the top of the shoulder where the acromion process and the clavicle meet to form a joint see the following image. The subacromial space lies directly inferior to the acromion, coracoid process, acromioclavicular joint, and coracoacromial ligament figure 301.
Pdf surgical treatment of acromioclavicular luxation. The main joint of the shoulder is the glenohumeral joint. Acromioclavicular separation discharge care what you need. The authors discussed the diagnosis of acromioclavicular joint dislocations and stated, stress views taken with weights suspended from each wrist will provide the diagnosis. Recently a new option has become available with the minimallyinvasive tight rope technique.
Symptoms include pain which may make it difficult to move the shoulder and often a deformity. There is a spectrum of ac joint traumatic injuries that ranges from a ligament sprain to a complete dislocation. Degeneration of the ac joint can be painful and can cause difficulty using the shoulder for everyday activities. Abnormal widening of the ac joint due to disruption of the ac ligament. The ac joint is the connection between the scapula shoulder blade and the clavicle collarbone. A partial dislocation is referred to as a subluxation. Acromioclavicular injury radiology reference article. Feb 03, 2020 an acromioclavicular uhkromeeokluhvikuler injury is an injury that causes the shoulder and collarbone to change position. During the first 2 weeks, patient may carefully remove the abduction sling for hygiene and supported codmans only.
Despite its low morbidity, some complications can occur. The acromioclavicular ac joint is formed by the cap of the shoulder acromion and the collar bone clavicle. The acromioclavicular joint acj is one of the more common sites of shoulder girdle injury, accounting for 412% of all such injuries, with an incidence of 34 cases per 100 000. Oct 02, 2017 weightlifters shoulder pain from an unstable ac joint feat. Case report diagnosis and management of grade ii acromioclavicular joint separation anna kiner 236 the circle, queen elisabeth street, london se1 2jn, uk. The first surgical repair of an acute ac dislocation is credited to sir samuel cooper who, back in 1861, used a loop of silver wire. The patellar ligament is the distal portion of the common tendon of the quadriceps femoris, which is continued from the patella to the tibial tuberosity. Acromioclavicular joint injury acromioclavicular joint. Diagnosis and management of grade ii acromioclavicular joint. Altogether, separation of the acromioclavicular joint accounts for 46 % of all joint. The top of the wing bone or scapula is the acromion.
Several classifications have been proposed to describe ac joint injuries. The ac joint is formed by the junction of the lateral clavicle and the acromion process of the scapula and is a gliding, or plane style synovial joint. A shoulder separation is not truly an injury to the shoulder joint. An acromioclavicular ac joint injury is commonly referred to as shoulder separation and should not be confused with a shoulder dislocation your acromioclavicular joint or ac joint is the joint at the top of your shoulder between your clavicle. It is the junction between the shoulder blade acromion and collar bone clavicle. The steroid medication is a powerful antiinflammatory medication. The ac joint is where the collarbone clavicle meets the highest point of the shoulder blade acromion. An acromioclavicular separation as, or shoulder separation, is when your shoulder and collarbone move or come apart. Simple distorsion, partial lesion of the ligaments without instability of the clavicle. Acromioclavicular joint reconstruction protocol immobilization phase 06 weeks full time in abduction slingthe arm must not be unsupported when the patient is in the upright position for the first 6 weeks.
Download acrobat pdf file 161kb icmje author disclosure forms. Osteoarthritis of the acromioclavicular joint is a common source of shoulder pain that is often neglected by clinicians and researchers. Ac joint injury is common in athletes and a source of significant morbidity, particularly for athletes in overhead sports. The second group of 12 patients underwent a newer techinque with the hook plate hook plate group. These exercises for acromioclavicular joint pain work to strengthen the muscles surrounding the ac joint and providing more stability around the actual ac joint. It is commonly caused by a fall directly on the point of the shoulder or a direct blow received in a contact sport. Diagnosis and management of grade ii acromioclavicular. Acj separations are graded according to severity from grade i being a mild sprain to grade vi, which is severe dislocation with displacement. Acromioclavicular joint injuries are among the most common shoulder girdle injuries in athletes and most commonly result from a direct force to the acromion with the arm in an adducted position. An ac joint injection is the injection of a steroid synthetic cortisone medication into the ac joint, which is located in the front portion of the shoulder. Acromioclavicular joint sternoclavicular joint the shoulder also has one articulation, which is the relationship between the scapula shoulder blade and the chest wall. An acromioclavicular joint separation, or ac separation, is a very frequent injury among physically active people.
These bones move or come apart because the ligament tissue that holds the bones in place is stretched or torn. Oct 22, 2018 injuries in and around the shoulder, including acromioclavicular joint injuries, occur most commonly in active or athletic young adults. A taping technique for the treatment of acromioclavicular. Disruption of acromioclavicular and coracoclavicular ligaments is a common injury of the shoulder. Surgical treatments using wolters hook plates provide satisfactory results in five cases of acromioclavicular luxations and four cases with distal clavicular fractures.
While most injuries can be managed nonoperatively, highgrade separations may result in persistent pain or functional decline and require surgical intervention 49. Various surgical techniques have been described for the fixation of acromioclavicular ac dislocations. Diagnosis of acromioclavicular joint dislocations letters. Developmental variations reported as high as 19% fall on shoulder is frequent mechanism of injury.
The surgical treatment of acromioclavicular joint injuries. All the patients had ac luxation of higher degree, stage ivvi acording to the rockwood scale. Acromioclavicular ac joint injuries are common in the athletic population, particularly in those who participate in contact sports. The trigeminal nerve originates from three sensory nuclei mesencephalic, principal sensory, spinal nuclei of trigeminal nerve and one motor nucleus motor nucleus of the trigeminal nerve extending from the midbrain to the medulla. Some are immovable, such as the sutures where segments of bone are fused together in the skull. Acromioclavicular ac joint separations are common injuries that affect the shoulder girdle. He completed his medical degree at the uniformed services university of the health sciences and his. The joint formed where the acromion connects to the collar bone or clavicle is the ac joint. Acromioclavicular joint injury clinical presentation. The use of metal wires, called kirschner wires, is a simple and effective fixation method for the correction of shoulder fractures and of dislocations in orthopedic surgery. Acromioclavicular stabilization orthopaedic surgery. A tunnel for the tightrope is prepared with a cannulated drill bit passing through the clavicle and the coracoid process. Physio fitness physio rehab tim keeley 123,788 views. Diagnosis and management of grade ii acromioclavicular joint separation 25.
Athletes from contact sports are more likely to suffer from ac. Pdf on aug 1, 1988, j bartonicek and others published surgical treatment of acromioclavicular luxation find, read and cite all the research you need on researchgate. A separated shoulder, also known as acromioclavicular joint injury, is a common injury to the acromioclavicular joint. Once the patient is in the correct position, the initial incision is completed based on langers lines to provide a more cosmetic scar. Discrete mobility of the clavicle in the piano key vertical mobility, without any anteroposterior mobility. Evaluation and treatment of acromioclavicular joint. Acute traumatic injuries occur with contact and collision sports, horse riding and motorsports. We thus talk of acromioclavicular luxation that can result in fatigability, pain and a visible deformation. Wire migration during the postoperative followup is a possible complication of the procedure. The proper diagnosis of acromioclavicular joint osteoarthritis requires a thorough physical exam, plainfilm radiograph, and a diagnostic local anesthetic injection. Acromioclavicular joint separations grades iiii springerlink. The acromioclavicular ligaments are slack but not broken. Acromioclavicular separation what you need to know. Shamus, pt, cscs t he shoulder is a complex anatomical structure that is comprised of several joints that permit a great deal of mobility without sacrificing the inherent stability 1.
Arm elevation causes the acromion to glide superiorly on the distal clavicle. Acromioclavicular joint injuries usually occur from a direct blow or following a fall onto the shoulder with an adducted arm. The outer end of the clavicle is held in alignment with the acromion by the acromioclavicular ligaments and the coracoclavicular cc ligaments. The authors present the case of a 48yearold male patient, a business administrator, who suffered a fall from his own height. Inferior plane of the distal clavicle should be on same plane as inferior border of acromion. We report our experience using the wolter clavicular plates for these injuries. Treatment options for acromioclavicular joint separation written by li fenglong and jiang chunyan, china. This joint, like most joints in the body, has a cartilage disk or meniscus inside and the ends. The acromioclavicular joint is located in the shoulder, the joint that connects the collarbone also called the clavicle the upper section of the shoulder blade known as the acromion. Shoulder injuries abstract anacromioclavicular acjointseparationorsprainisatraumaticseparation or compression of the ac joint causing the capsular holding elements and soft to be stretched beyond their plastic limit. It is supported and stabilised by the capsule of the joint and ligaments. Since the acromioclavicular is a planar joint, small movements occur in all three planes. Dec 23, 2012 acromioclavicular joint acj separation injuries are common injuries among sporting populations. In this injury the clavicle collar bone separates from the scapula shoulder blade.
Acromioclavicular ac joint instability is a fairly common and particularly limiting injury that may result in persistent pain and reduced quality of life. Acromioclavicular joint an overview sciencedirect topics. The ac acromioclavicular joint southern california. According to the rockwood classification, acd is classified into six types type ivi. They recommended conservative management with compressive bandages to keep the clavicle in a normal position.
However, recurrent dislocation is one of the main complications associated with the majority of these techniques. Patients are most often young and active in sports. Dislocations are often caused by sudden trauma on the joint like an impact or fall. We report a case of postoperative ac joint redislocation. Surgical treatment of acromioclavicular joint injury. To test movement of this joint on yourself, simply glide your right index finger laterally along the superior surface of your left clavicle beginning at the sternoclavicular joint. The arthrex tightrope system is a device that consists of two buttons one round clavicle button and one oblong coracoid button. There is consensus in the literature that grade iiii acj separations are managed conservatively and grades ivvi are managed surgically. The kirschner wire is a widely accepted option due to its easy and smooth handling. The ac joint is located at the outer end of the clavicle where it attaches to the acromion of the scapula. Acromioclavicular joint dislocation occurs as a result of an acute traumatic event.
Operative treatment of acute acromioclavicular joint. Surgical treatment of acromioclavicular luxation and. All patients with acromioclavicular luxations had tossy type iii lesions, and neer type ii lesions were present in three patients with distal clavicular fractures. The incidence of acromioclavicular joint separation varies with the sportive activity and can reach up to 20 % in skiing. A patients guide to acromioclavicular joint separation introduction. Acromioclavicular definition of acromioclavicular by the. Usually there is a protuberance or bump in this area, which can be quite large in some people normally. Diagnosis and management of grade ii acromioclavicular joint separation anna kiner 236 the circle, queen elisabeth street, london se1 2jn, uk. He is a graduate of marquette university where he obtained a b. Gravity pulls the shoulder and the scapula downwards and the muscles pull the collarbone upwards figure 2 and photo 1. This pushes the acromion forcibly inferiorly and medially with respect to the clavicle 7.
Luxation of the acromioclavicular ac joint is a common sports injury. The incision is first marked, beginning at the coracoid process and extending to the most proximal aspect of the clavicle to ensure a good overall exposure of the ac and coracoclavicular joint space. Acromioclavicular joint definition of acromioclavicular. Acromioclavicular joint pain, or ac joint pain, can be reduced with specific exercises. Repetitive traumatic injuries occur with overhead sports, boxing and weightlifting. A joint dislocation, also called luxation, occurs when there is an abnormal separation in the joint, where two or more bones meet. Research article injuries of the shoulder sustained by.