Acromioclavicular Injury Clinical Presentation

  • Author: Moira Davenport, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Feb 9, 2011
 

History

AC injury often involves a fall onto the apex of the shoulder, usually with the arm in adduction. Severe forces resulting from significant falls are often associated with type III-VI injuries. Patients usually present with pain at the top of the shoulder at the acromioclavicular joint and can often be seen carrying the affected arm close to the side of their bodies. Alternatively, patients use the unaffected arm to splint the injured extremity. Abrasions and ecchymoses are common at the site of impact.

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Physical

While examining the stability of the affected shoulder, the midshaft of the clavicle should be manipulated rather than the AC joint itself. The patient should be asked to place the hand of the affected side on the opposite shoulder while the examiner applies downward force on the affected elbow, trying to elicit pain at the AC joint. Patients may also experience pain upon direct palpation of the AC joint. Several techniques to directly assess the AC joint are discussed in the orthopaedic literature, although none of these maneuvers has been shown to have a high sensitivity or specificity.

Palpating the bony structures of the shoulder for any stepoff that might suggest occult fracture as well as noting any displacement of the clavicle are important. A thorough neurovascular examination to rule out brachial plexus injury is also essential, although concomitant neurovascular injury is relatively rare in AC joint injuries.

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Causes

Downward blunt force on the acromion results in variable injury to the AC and CC ligaments. Other injuries, depending on the force of injury, may include tears of the deltoid and trapezius attachments at the clavicle and fractures of the acromion, clavicle, and coracoid (or of their cartilaginous attachments).

Athletes participating in contact sports, such as football and martial arts, are at increased risk of AC joint injuries. Patients involved in motor vehicle collisions with direct trauma to the apex of the shoulder are also at risk for AC injuries.

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Contributor Information and Disclosures
Author

Moira Davenport, MD  Attending Physician, Departments of Emergency Medicine and Orthopedic Surgery, Allegheny General Hospital

Moira Davenport, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Joseph Kim, MD  Chairman, Department of Emergency Medicine, Western Medical Center; Clinical Instructor, University of California, Irvine, School of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Roy Alson, MD, PhD, FACEP, FAAEM  Associate Professor, Department of Emergency Medicine, Wake Forest University School of Medicine; Medical Director, Forsyth County EMS; Deputy Medical Advisor, North Carolina Office of EMS; Associate Medical Director, North Carolina Baptist AirCare

Roy Alson, MD, PhD, FACEP, FAAEM is a member of the following medical societies: Air Medical Physician Association, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, National Association of EMS Physicians, North Carolina Medical Society, Society for Academic Emergency Medicine, and World Association for Disaster and Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Tom Scaletta, MD  Chair, Department of Emergency Medicine, Edward Hospital; Past-President, American Academy of Emergency Medicine

Tom Scaletta, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Cappi Lay, MD, to the development and writing of this article.

References

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Anteroposterior (AP) radiograph of right shoulder showing step-off of acromioclavicular (AC) joint.
 
 
 
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