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Acromioclavicular (AC) joint injuries most commonly occur in young adults involved in
sports and overhead activities. They account for 3% of all shoulder injuries and 40% of shoulder
sports injuries. The person who sustains an AC injury commonly reports direct or indirect
mechanisms of injury. Direct force is when the person falls on to the point of the shoulder, with the
arm usually at the side and adducted. The force drives the acromion downwards and medially.
Indirect force is when the person falls onto an outstretched arm. The force is transmitted through the
humeral head to the acromion, therefore the acromioclavicular ligament is disrupted and the
coracoclavicular ligament is stretched. Is very importante to identify the injury type, because the
treatment and prognosis hinge on an accurate diagnosis? The AC injuries are classified as grades I, II
and III, representing respectively, no involvement, partial tearing, and complete disruption of the
coracoclavicular ligaments. More recently, Rockwood has further classified the more severe injuries
as grades I-VI. The treatment of AC joint injuries varies according to the severity or grade of the
injury. Ice packs, anti-inflammatories and a sling are used to immobilise the shoulder and take the
weight of the arm. As pain starts to subside, it is important to begin moving the fingers, wrist and
elbow, than shoulder to prevent stiffness. Undisplaced injuries only require rest, ice, and then gradual
return to activity over a 2-6 week period. Surgical repair can be divided into: acromioclavicular
repairs; coracoclavicular repairs; distal clavicular excision and dynamic muscle transfers.
Disadvantages of surgery are that there are risks of infection, a longer time to return to full function
and continued pain in some cases. For the patient with a chronic AC joint dislocation or subluxation
that remains painful after 3 to 6 months of closed treatment and rehabilitation, surgery is indicated to
improve function and comfort. For sequelae of untreated type IV-VI, or painful type II and III
injuries, the Weaver Dunn technique is advocated. Postoperatively, the arm is supported in a sling for
up to 6 weeks. After the first 2 weeks, the patient is allowed to use the arm for daily activities at waist
level. After 6 weeks, the sling or orthosis is discontinued, overhead activities are allowed. AC joint
injuries are an important source of pain in the shoulder region and must be evaluated carefully. Type I
and II injuries are treated symptomatically. The current trend in uncomplicated type III injuries is a
non-operative approach. If it develops subsequent problems, a delayed reconstruction may be
undertaken. Type IV- VI injuries are generally treated operatively. |
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