Acromioclavicular Injury Workup

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

Imaging Studies

Standard radiographs of the shoulder should be obtained (see image below).

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

To optimally image the AC joint, a cross body adduction radiograph should be obtained. A radiograph of the entire upper thorax is useful to compare the vertical distance between the clavicle and the coracoid process on both sides. Radiographic results according to severity of injury are as follows:

  • Type I - Normal
  • Type II - Subluxation of AC joint space less than 1 cm; normal CC space
  • Type III - Subluxation of AC joint space more than 1 cm; widening of the CC space more than 50%
  • Types IV-VI - Subluxation of AC joint space more than 1 cm, widening of the CC space more than 50%; associated displacement of the clavicle

Stress radiographs (10-lb weight in each hand) may help distinguish type I from type II injuries, but many authorities consider such studies unnecessary. Stress views are of limited value as any involuntary splinting by the patient prevents full visualization of the AC joint and may simply serve to increase the patient's pain.

With complete AC/CC ligament rupture, cross body adduction films will show the scapula rotated anteromedially and the acromion will migrate medially.

Assess the clavicle and scapula for associated fractures.

For pediatric injuries, plain radiographs may reveal fractures at the base of the coracoid.

Obtain a chest radiograph if concern exists with regard pulmonary involvement.

Research has looked at the additional information provided by ultrasonographic examination of the AC joint in suspected high-grade injuries. Heers and Hedtmann showed that ultrasonographic examination of the AC joint in experienced hands had 100% sensitivity for diagnosis of deltoid muscle detachment and fascial disruption.[1] The study also showed 80% sensitivity and 100% specificity for disruption of the trapezius muscle. More studies are necessary to evaluate the potential for ultrasonography in the routine examination of suspected AC injury.

MRI should be considered to further delineate the extent of AC joint injury, particularly in highly competitive athletes.

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Procedures

Reduction of AC injuries is rarely attempted in the emergency department. Such maneuvers should only be performed in cooperation with an orthopedic surgeon.

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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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