Acromio-Clavicular Injury

Presentation

Symptoms pain Physical exam palpate for lateral clavicle or AC joint tenderness observe for abnormal contour of the shoulder compared to contralateral side check for stability AP stability assesses AC ligaments vertical stability assesses CC ligaments Imaging Radiographs bilateral AP compare displacement to contralateral side measured as distance from top of coracoid to bottom of clavicle 1/3 penetration on AP to visualize AC joint axillary lateral  required to diagnose Type IV (posterior) zanca view   performed by tilting the x-ray beam 10° to 15° toward the cephalic direction and using only 50% of the standard shoulder anteroposterior penetration strength.   stress views  no longer used Treatment Nonoperative ice, rest and sling for 3 weeks  indications Type I and II  Type III in most individuals rehab early ROM regain functional motion by 6 weeks return to normal activity at 12 weeks complications AC joint arthritis chronic subluxation and instability Operative ORIF or ligament reconstruction indications Type III in laborers and elite athletes Type IV Type V Type VI contraindications patient unlikely to comply with postoperative rehabilitation skin problems over fixation approach site rehabilitation sling immobilization without abduction for 6 weeks no shoulder ROM for 6 weeks generally return to full activity after 6 months