Treatment of Acromio-clavicular Joint Dislocation

Anatomy of the Acromio-clavicular Joint or ACJ

• The acromio-clavicular joint joins the collarbone to the shoulder blade and hence links the arm to the axial skeleton.

Mechanism of Injury

• The athlete who sustains an acromio-clavicular injury commonly reports either one of two mechanisms of injury, direct or indirect.
• Direct force: This is when the athlete 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. 70% of acromio-clavicular joint injuries are the result of a direct injury.
• Indirect force: This is when the athlete falls onto an outstretched arm. The force is transmitted through the humeral head to the acromion, therefore the acromio-clavicular ligament is disrupted and the coraco-clavicular ligament is stretched.

Treatment

• Type I, II, and some III injuries can generally be managed without surgery.
  However, these injuries may result in persistent shoulder pain, dysfunction, or both in the future.
• Type I and II separations may progress to develop symptomatic degenerative disease.
• Type III separations may result in impingement symptoms, and muscle-fatigue discomfort.
• Late surgical management may be required.
  
  

Treatment of Type III Injuries

• An area of controversy.
• Many surgeons believe that this degree of displacement leads to muscle-fatigue discomfort and difficulty manipulating heavy loads.
• As a result, operative intervention should be considered in heavy labourers and younger patients who are athletic.
  

Treatment

• Type IV, V, and VI injuries generally require surgical repair.
• As the clavicle is so far displaced from the acromial process in the posterior, superior, or inferior direction, respectively, conservative management is inadequate.
• The patient continues to experience pain and dysfunction if the articulation is not reduced and stabilized.
  
  

Please note that the information contained herein is for general medical information only.
If you have any specific medical condition or queries, please consult your medical doctor.

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