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Acromioclavicular-Joint-Dislocation
Acromioclavicular Joint Dislocation

The Acromioclavicular joint is where your collarbone (clavicle) meets the top-most potion of your shoulder blade (acromion); thus the word – acromioclavicular. Strong ligaments hold them together. These ligaments are the coraco-clavicular ligament and acroclavicular ligaments.

Acromioclavicular joint dislocation is particularly common in collision sports such as football, judo, and rugby -to name a few. It’s also a problem for those who participate in swimming, horseback riding, biking, or skateboarding. The most common mechanism of injury is a fall injuring the tip of the shoulder.

Chief Complaints

Most patients injured the shoulder moments before seeking medical attention. A dislocated shoulder is usually associated with an obvious dislocated appearance, pain, swelling, and/or the inability to move your shoulders and arms.

Physical Examination

Through hands on examining, pull-apart testing, and flexion exercise, our orthopedic specialists can determine the extent of the injury and properly grade the injury.

Radiologic Studies

Though symptoms could show obvious signs of dislocation, images are still needed to confirm the diagnosis. 

Shoulder X-ray will then show obvious changes especially in the acromioclavicular joint.

Ultrasound can be used to visualize bones, as well as soft tissues surrounding the joint. 

Magnetic Resonance Imaging (MRI) can be used to tell if a bone is broken when x-ray results are not clear. MRI is done more commonly than other tests to check for bone and joint problems. It shows abnormal tissues and ligaments more clearly.

Sometimes the deformity can be minimal and may not be apparent on the images. The orthopedic specialist may then request another view of the area, but this time asking the patient to carry weight on the affected shoulder.

Diagnosis

AJD is graded I-VI depending on the degree of separation to the acromion from the clavicle with weight applied to the arm. It can be categorized as follows:

  • Grade I – has slight displacement of the joint and it has the normal separation of <4mm.
  • Grade II – has partial dislocation and complete disruption of the AC joint. The gap is >5mm.
    *Grade I and II does not require surgery but most cases for young athletes, surgery is required also.
  • Grade III – is a complete disruption of the ligament as well as tearing of the joint capsules. The joint is very tender and swollen on examination.
    *Grade III separations most often do not require surgery and shoulder function should return to normal after 16–20 weeks. However, there will be some physical deformity of the shoulder with a noticeable bump resulting from the dislocation of the clavicle.
  • Grade IV-VI – involves the clavicle and requires immediate surgery. A person with an AJD shows prominence on the top of the shoulder and pain with any activities of that arm. In cases where the clavicle was affected and pushed clearly, it may become serious and most painful.

Treatment

With minimal deformity, conservative treatments may be done to alleviate symptoms. This would include the following:

  • Icing as ice has its anti-inflammatory effects.
  • Shoulder Sling is used to maintain the shoulder in a resting position helping it avoid excessive movements and further strain.
  • Physical Therapy as it helps restore movements and improve strength.

For severe cases such as when patients feel persistent pain and have apparent deformity, surgery may be done to fix the deformity, regain alignment of the shoulder, and avoid further dislocation.

Surgery aims to reconstruct the damaged ligaments and may require the use of pins, plates, screws or sutures. Your orthopedic specialist may recommend trimming of the collarbone so that there will be no friction to the acromion. If the ligaments are broken, a reconstruction may be done. Surgery may be done in different ways, some are as follows

  • Arthroscopic Repair – A minimally invasive surgical procedure that typically leaves 3 or less incisions. It involves the use of an arthroscope to examine and treat the damage.
  • Acromioclavicular Joint Surgery – This would require an incision to acquire access to the affected area.

Complications

As there has been a disruption to the normal anatomy, complications may occur especially when the doctor’s advice is not followed precisely. The most common complications of surgery include infection, nerve and blood vessel injurys, continued pain or stiffness, fracture, unsuccessful surgery, ligaments re-tear, and revision surgery.
Always remember that with any treatment, whether conservative or surgical, your shoulder needs rehabilitation to regain range of motion, stability, and strength. A sling may be needed to support and protect the shoulder.

Do take note that all movements and activities above the shoulder level must be avoided for first 12 weeks following surgery. This being said, driving should be avoided as well.
Some surgeries especially those that affects the ligament can be delayed, so there is no rush with treatments. Your orthopedic specialist can tell you more about this and may help you weigh the pros and cons of having treatments.

Have you had dislocations before or suspect that you have issues with your shoulder? Get evaluated and better understand the condition of your shoulder Click here to book an appointment with our orthopedic specialist.

Rehabilitation is better managed with trained physiotherapists, and we have all of them here at Orthosports Medical Center. Click here to book an appointment with our physiotherapists.