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.
|
