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.