Treatment options for acromioclavicular joint separation written by li fenglong and jiang chunyan, china. He completed his medical degree at the uniformed services university of the health sciences and his. It is the junction between the shoulder blade acromion and collar bone clavicle. 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. Acromioclavicular joint sternoclavicular joint the shoulder also has one articulation, which is the relationship between the scapula shoulder blade and the chest wall.
Athletes from contact sports are more likely to suffer from ac. 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. 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. It is commonly caused by a fall directly on the point of the shoulder or a direct blow received in a contact sport. The top of the wing bone or scapula is the acromion. There is a spectrum of ac joint traumatic injuries that ranges from a ligament sprain to a complete dislocation.
Arm elevation causes the acromion to glide superiorly on the distal clavicle. The ac joint is where the collarbone clavicle meets the highest point of the shoulder blade acromion. These exercises for acromioclavicular joint pain work to strengthen the muscles surrounding the ac joint and providing more stability around the actual ac joint. The steroid medication is a powerful antiinflammatory medication. Surgical treatment of acromioclavicular joint injury. A shoulder separation is a fairly common injury, especially in certain sports. Injury may occur as a consequence of throwing sports or chronic. This pushes the acromion forcibly inferiorly and medially with respect to the clavicle 7. Because this injury can masquerade as other shoulder conditions, the examiner must understand the anatomy and biomechanics of the shoulder in order to perform a systematic clinical evaluation and identify the injury. The incidence of acromioclavicular joint separation varies with the sportive activity and can reach up to 20 % in skiing. The strong accessory coracoclavicular ligament is the main stabilizer of the acj, particularly at large degrees of separation, 9. Discrete mobility of the clavicle in the piano key vertical mobility, without any anteroposterior mobility.
Usually there is a protuberance or bump in this area, which can be quite large in some people normally. Case report diagnosis and management of grade ii acromioclavicular joint separation anna kiner 236 the circle, queen elisabeth street, london se1 2jn, uk. Surgical treatments using wolters hook plates provide satisfactory results in five cases of acromioclavicular luxations and four cases with distal clavicular fractures. Osteoarthritis of the acromioclavicular joint is a common source of shoulder pain that is often neglected by clinicians and researchers. Acromioclavicular stabilization orthopaedic surgery. The most common presentation was for chronic pathology. Despite its low morbidity, some complications can occur. The acromioclavicular joint, or ac joint, is one of four joints that compride the shoulder complex. The ac acromioclavicular joint southern california. The ac joint is located at the outer end of the clavicle where it attaches to the acromion of the scapula. Oct 22, 2018 acromioclavicular joint injuries are often seen after bicycle wrecks, contact sports, and car accidents. The main joint of the shoulder is the glenohumeral joint. According to tossy et al 5 and allman, 6 type i lesions show a wellaligned joint with strained ligaments.
Dec 23, 2012 acromioclavicular joint acj separation injuries are common injuries among sporting populations. Diagnosis and management of grade ii acromioclavicular. Acute traumatic injuries occur with contact and collision sports, horse riding and motorsports. The acromioclavicular ac joint is formed by the cap of the shoulder acromion and the collar bone clavicle. It is supported and stabilised by the capsule of the joint and ligaments. While most injuries can be managed nonoperatively, highgrade separations may result in persistent pain or functional decline and require surgical intervention 49. Several classifications have been proposed to describe ac joint injuries. A thorough history, physical examination, and imaging evaluation are critical to establish the correct diagnosis, guide treatment, and ensure optimal outcomes.
At the level of the pons, the sensory nuclei merge to form a. Treatment options for acromioclavicular joint separation. Download acrobat pdf file 161kb icmje author disclosure forms. Oct 22, 2018 injuries in and around the shoulder, including acromioclavicular joint injuries, occur most commonly in active or athletic young adults. Acromioclavicular joint dislocation occurs as a result of an acute traumatic event.
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. A taping technique for the treatment of cromiocavicuar joint sprains. Acromioclavicular ac joint injection what is an ac joint injection. Acromioclavicular joint an overview sciencedirect topics. Acromioclavicular joint separations grades iiii springerlink. Acromioclavicular ac joint instability is a fairly common and particularly limiting injury that may result in persistent pain and reduced quality of life. 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 ac joint is the connection between the scapula shoulder blade and the clavicle collarbone. A taping technique for the treatment of acromioclavicular. Gravity pulls the shoulder and the scapula downwards and the muscles pull the collarbone upwards figure 2 and photo 1. The injury actually involves the acromioclavicular ac joint.
There are several methods for treatment of acromioclavicular luxation and distal clavicular fracture. Some are immovable, such as the sutures where segments of bone are fused together in the skull. The surgical treatment of acromioclavicular joint injuries. 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. Research article injuries of the shoulder sustained by. Operative treatment of acute acromioclavicular joint. These bones move or come apart because the ligament tissue that holds the bones in place is stretched or torn. Acromioclavicular joint injuries and, more specifically, separations are commonplace both in general practice and during athletic participation.
There is a spectrum of ac joint traumatic injuries that ranges from a ligament sprain to a complete. Inferior plane of the distal clavicle should be on same plane as inferior border of acromion. Whereas clinical studies justify the medical use, risks and benefits remain unclear. 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. Operative treatment of acromioclavicular joint injuries is recommended for higher degree dislocations. The diagnosis and treatment of acute dislocation of the. They recommended conservative management with compressive bandages to keep the clavicle in a normal position. Acromioclavicular joint disruption mechanism of injury. A shoulder separation is not truly an injury to the shoulder joint. The acromioclavicular ac joint in the shoulder is a common spot for osteoarthritis to develop in middle age. The authors discussed the diagnosis of acromioclavicular joint dislocations and stated, stress views taken with weights suspended from each wrist will provide the diagnosis. Physio fitness physio rehab tim keeley 123,788 views.
Imaging can be used to classify acromioclavicular injuries, with the rockwood system most commonly used to. Clinical comparison of two types of hook plate in surgical. A patients guide to acromioclavicular joint separation introduction. Disruption of acromioclavicular and coracoclavicular ligaments is a common injury of the shoulder. Acromioclavicular dislocation acd is a common injury. Of, relating to, or affecting both the scapula and the clavicle. However, recurrent dislocation is one of the main complications associated with the majority of these techniques. This information leaflet is produced by health professionals who are expert in improving musculoskeletal. Ac joint injury is common in athletes and a source of significant morbidity, particularly for athletes in overhead sports. Biomechanics and treatment of acromioclavicular and. Diagnosis and management of grade ii acromioclavicular joint separation 25. Pdf surgical treatment of acromioclavicular luxation.
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. Acromioclavicular joint acj injuries are very common sporting injuries. Acromioclavicular separation what you need to know. Altogether, separation of the acromioclavicular joint accounts for 46 % of all joint. 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. 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. 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. The outer end of the clavicle is held in alignment with the acromion by the acromioclavicular ligaments and the coracoclavicular cc ligaments. Acromioclavicular joint pain, or ac joint pain, can be reduced with specific exercises. He is a graduate of marquette university where he obtained a b. Luxation of the acromioclavicular ac joint is a common sports injury.
The acromioclavicular ligament is a capsular ligament which maintains horizontal stability in the anteroposterior plane and protects against posterior translation and axial distraction of the clavicle. Listen to the audio pronunciation in the cambridge english dictionary. 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. 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.
Degeneration of the ac joint can be painful and can cause difficulty using the shoulder for everyday activities. However, pediatric acromioclavicular injuries have also increased owing to the rising popularity of dangerous summer and winter sporting activities. The first studies on acromioclavicular ac luxation repair were by hippocrates, galen, and paul of aegina. Developmental variations reported as high as 19% fall on shoulder is frequent mechanism of injury. The bones move or come apart because the ligaments that hold the bones in place are stretched or torn. Acromioclavicular joint pain or ac joint pain is a common issue that occurs in many people, especially those with active lifestyles. 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. It is also sometimes called the patellar tendon as it is a continuation of the quadriceps tendon. Dislocations are often caused by sudden trauma on the joint like an impact or fall. Diagnosis of acromioclavicular joint dislocations letters. Acromioclavicular ac joint injuries are more common than sternoclavicular sc joint injuries. Repair of complete acromioclavicular separations using the acromioclavicular hook plate. Evaluation and treatment of acromioclavicular joint. The proper diagnosis of acromioclavicular joint osteoarthritis requires a thorough physical exam, plainfilm radiograph, and a diagnostic local anesthetic injection.
Acromioclavicular joint injury clinical presentation. The arthrex tightrope system is a device that consists of two buttons one round clavicle button and one oblong coracoid button. Depending on its severity, the injury is associated with rupture of the acromioclavicular and coracoclavicular ligaments. 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. There is consensus in the literature that grade iiii acj separations are managed conservatively and grades ivvi are managed surgically. 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.
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. Repetitive traumatic injuries occur with overhead sports, boxing and weightlifting. The average age of the two groups was very similar, with 28 being the average age of the zuggbosw group, and 25 of the hook plate group. Surgical treatment of acromioclavicular luxation and. We thus talk of acromioclavicular luxation that can result in fatigability, pain and a visible deformation. Range of motion exercises with or without weights are very helpful in reducing pain and are discussed in this article. This joint comprises a ball the humeral head on a golfteeshaped joint the glenoid of the scapula. In order to overcome recurrent dislocation after revision surgery, a reconstruction of the conoid and trapezoid. Since the acromioclavicular is a planar joint, small movements occur in all three planes.
The subacromial space lies directly inferior to the acromion, coracoid process, acromioclavicular joint, and coracoacromial ligament figure 301. 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 separation discharge care what you need. 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. Acj separations are graded according to severity from grade i being a mild sprain to grade vi, which is severe dislocation with displacement. Is acromioclavicular joint pain your biggest problem.
The kirschner wire is a widely accepted option due to its easy and smooth handling. 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. 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. The authors present the case of a 48yearold male patient, a business administrator, who suffered a fall from his own height. Acromioclavicular ac joint injuries account for nearly half of all shoulder injuries among athletes involved in contact sports. Wire migration during the postoperative followup is a possible complication of the procedure. Diagnosis and management of grade ii acromioclavicular joint.
In this injury the clavicle collar bone separates from the scapula shoulder blade. Acromioclavicular injury radiology reference article. A joint dislocation can cause damage to the surrounding ligaments, tendons, muscles, and nerves. 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. An acromioclavicular separation as, or shoulder separation, is when your shoulder and collarbone move or come apart.
Most shoulder separations are actually injuries to the acromioclavicular ac joint. Simple distorsion, partial lesion of the ligaments without instability of the clavicle. 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. 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. Tightrope fixation of complex acromioclavicular separation. Feb 03, 2020 an acromioclavicular uhkromeeokluhvikuler injury is an injury that causes the shoulder and collarbone to change position.
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. Shamus, pt, cscs t he shoulder is a complex anatomical structure that is comprised of several joints that permit a great deal of. Abnormal widening of the ac joint due to disruption of the ac ligament. A separated shoulder, also known as acromioclavicular joint injury, is a common injury to the acromioclavicular joint. Acromioclavicular joint injury acromioclavicular joint. A joint dislocation, also called luxation, occurs when there is an abnormal separation in the joint, where two or more bones meet. There is a wide spectrum of acute and chronic shoulder injuries sustained by surfers. We report our experience using the wolter clavicular plates for these injuries. Case reports in medicine hindawi publishing corporation. The acromioclavicular ligaments are slack but not broken. 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. A partial dislocation is referred to as a subluxation. The second group of 12 patients underwent a newer techinque with the hook plate hook plate group. All patients with acromioclavicular luxations had tossy type iii lesions, and neer type ii lesions were present in three patients with distal clavicular fractures.
Patients are most often young and active in sports. The joint formed where the acromion connects to the collar bone or clavicle is the ac joint. Acromioclavicular definition of acromioclavicular by the. 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. 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. Acromioclavicular dislocation can be treated using several surgical techniques. 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. During the first 2 weeks, patient may carefully remove the abduction sling for hygiene and supported codmans only. A tunnel for the tightrope is prepared with a cannulated drill bit passing through the clavicle and the coracoid process. An acromioclavicular joint separation, or ac separation, is a very frequent injury among physically active people. Acromioclavicular joint injuries usually occur from a direct blow or following a fall onto the shoulder with an adducted arm.
All the patients had ac luxation of higher degree, stage ivvi acording to the rockwood scale. This joint, like most joints in the body, has a cartilage disk or meniscus inside and the ends. Acromioclavicular ac joint separations are common injuries that affect the shoulder girdle. Acromioclavicular ac joint injuries are common in the athletic population, particularly in those who participate in contact sports. Others, such as those between the vertebrae, are gliding. Various surgical techniques have been described for the fixation of acromioclavicular ac dislocations. 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. Once the patient is in the correct position, the initial incision is completed based on langers lines to provide a more cosmetic scar. Songclinical and radiologic outcomes of acute acromioclavicular joint. The coracoclavicular ligaments conoid and trapezoid ligament are major stabilizing components that prevent superior dislocation of the clavicle. According to the rockwood classification, acd is classified into six types type ivi. Diagnosis and management of grade ii acromioclavicular joint separation anna kiner 236 the circle, queen elisabeth street, london se1 2jn, uk. We report a case of postoperative ac joint redislocation.