ACJ Dislocation


The acromioclavicular joint is extremely strong, as it is the only joint connecting the entire arm to the clavicle. Injuries to this joint are a result of a direct blow to the shoulder, and are common in sportswomen/men. The spectrum of injuries to this joint are varied, from a minor strain to complete rupture of the ligaments and supporting capsule with gross instability. The primary ligaments that tether the clavicle to the acromion are the conoid and trapezoid, running from the coracoid process to the clavicle. Complete rupture of these results in superior clavicle displacement, with the shoulder appearing to drop down laterally.


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  • Management
Management

Management

Management of these injuries is a good example of emphasis on function and not form, as there may be quite step in the joint that appears unsightly, but the shoulder function is very good.There is a classification system that aids management decision making in these injuries. (picture of the Rockwood classification)

Non-operative

There is general consensus that grades 1 and 2 be managed non-operatively. Grade 3 is more controversial, but recent literature divides them into A and B, depending on the stability of the clavicular-acromial articulation at 3 weeks post injury. Grade 3A’s fare better with non-operative management while grade 3B’s require surgery.

Operative

Grades 3B-6 need to be managed operatively. At surgery, the conoid and trapezoid ligaments require a repair (if there is any ligament left to suture) and a reconstruction, in order to tether down the clavicle and reconstitute the normal acromio-clavicular articulation. This usually involves an open procedure, but may be done arthroscopically in select cases.

Postoperatively the arm is placed in a sling for 6 weeks, and range of motion of the elbow, wrist and hand is encouraged from day 1. Graduated shoulder strengthening may begin from 6 weeks, with the shoulder returning to normal after around 3 months from surgery.

Conditions Managed



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