ACROMIOCLAVICULAR JOINT INJURIES - SHOULDER SEPARATION

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ACROMIOCLAVICULAR JOINT INJURIES - SHOULDER
SEPARATION

• BY ISLAY DUFF, MEGHAN MAGNUSSON AND BECCA GRAZIANO

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The acromioclavicular joint

• Location
• Top of the shoulder
• Composed of
• 2 bones Acromion and Clavicle
• 2 ligaments Acromioclavicular and
  Coracoclavicular (seperated into conoid and the
  trapezoid sectors)
• - Ligaments provide stability for the joint
  tearing of the ligament can lead to
  acromioclavicular sprains and seperations

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How does this injury Occur?

• Sharp blows to the top of the shoulder
• Examples
• Sports-related accidents (Mostly high contact
  sports ie. Football and rugby)
• Falling (ie. off a bike or horse)
• Car accident

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SYMPTOMS OF shoulder separation

• Symptoms depend of the severity of the injury
• (classified by grades)
• Grade 1 Tenderness over joint and even
  throughout entire shoulder
• Grade 2 Grade 1 symptoms, swelling and Bruising
  around shoulder area
• Grade 3 Grade 1 2 symptoms, popping sensation,
  bump on shoulder, pain while moving shoulder
  (especially when raising arm above shoulder)

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Classifications of the joint injury

• BROKEN DOWN INTO 3 GRADE 6 TYPES (based on
  severity)
• Grade One TENDER BUT NOT SEPERATED
• Type I (Grade 1)
• - Injury to the capsule that surrounds the AC
  join
• - Bones are still in position
• - Primary symptom is pain

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CLASSIFICATION OF THE JOINT INJURY

• Grade Two SLIGHT SEPERATION OF THE CLAVICLE FROM
  THE SHOULDER
• Type II (Grade 2)
• AC (Acromioclavicular) joint capsule and ligament
  are partially torn
• Patients may have small bump over the AC joint
• Type III (Grade 2)
• Same type of injury as type II shoulder
  separation, yet more significant
• Patients have large bump over the AC joint

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Classifications of the joint injury

• Grade Three FULL SEPARATION OF SHOULDER
• Type IV (Grade 3)
• - unusual injury where the clavicle is pushed
  behind the AC joint
• Type V (Grade 3)
• - exaggerated type III injury
• - the muscle above the AC joint is punctured by
  the end of the clavicle causing a significant
  bump over the injury
• Type VI (Grade 3)
• also exceedingly rare
• the clavicle is pushed downwards, and becomes
  lodged below the coracoid (part of the scapula)

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Quick little video...

• http//www.youtube.com/watch?vOfcSvG-dgbY

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Treatments

• Nonsurgical
• -  Immobilize the arm using a sling or brace
• Cold therapy
• A sports injury specialist or doctor may tape
  the joint into correct healing position
• Anti-Inflammatory medicine to reduce swelling
  and pain
• After some healing physiotherapy is recommended
  to further healing 

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Treatments

• Surgical 
• -  reconstruction of ligaments
• trimming the end of the collarbone to prevent
  contact with the acromion (Mumford Procedure)
• plates and pins may be inserted to improve
  stability
• major seperations often require the Weaver-Dunn
  Procedure (A 2-inch incision is made over the
  joint, the end of the clavicle is removed,
  ligaments are transferred from the underside of
  the acromion into the cut end of the clavicle to
  replace torn ligaments)

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Rehabilitation

• Avoid sports until injury has healed
• Continue to move shoulder to prevent frozen or
  stiff shoulders
• With doctors permission work with trainer or
  physical therapist to strengthen shoulder (to do
  shoulder exercises)

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• Post-Rehab Prevention
• Pain-free range of motion of AC joint must be
  present before returning to sports
• Rehab exercises can help re-strengthen joint
• Taping of AC joint can support and protect joint
  by applying pressure to clavicle
• Shoulder supports and braces are available
• If pain persists patient can use ice and
  anti-inflammatory medication to reduce pain