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Acromioclavicular Joint Injury Clinical Presentation

  • Author: Brett D Owens, MD; Chief Editor: Craig C Young, MD  more...
 
Updated: Aug 27, 2015
 

History

An acromioclavicular joint injury should be considered in any patient complaining of pain over the superior part of the shoulder,[22] particularly after a fall either onto the apex of the shoulder or onto an outstretched hand. Patients may also notice restricted shoulder motion.

In the immediate setting, the patient may initially experience generalized shoulder tenderness and swelling; however, as the diffuse pain resolves, specific point tenderness over the acromioclavicular joint is usually noted.

The athlete may note a significant abrasion or prominence of the distal clavicle. Athletes involved in weight training typically experience pain with specific exercises such as with use of the bench press and dips.

Many individuals experience nocturnal pain and awakening when rolling onto the involved shoulder, which puts pressure on the acromioclavicular joint. Rarely, the patient may report popping or catching in the region of the acromioclavicular joint.

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Physical Examination

Patients have pain over the acromioclavicular joint. Swelling, bruising, and a prominent clavicle may be evident, depending on the type of sprain that the patient has sustained. In types I and II sprains, deformity is usually minimal.

In type III injuries, the distal clavicle is abnormally prominent. A prominent clavicle with loss of the normal contour of the shoulder caused by sagging of the acromion is highly suggestive of a ligamentous disruption of the acromioclavicular joint. Of note, clavicle fractures, without acromioclavicular joint sprains, can also cause the clavicle to be prominent.

With an acute injury, the patient has poor shoulder range of motion and moderate pain when trying to raise the arm. These patients 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. These findings may be clearer when the patient is asked to hold a 10- to 15-lb weight in the hand of the affected arm.

In the acute situation, the examiner may have difficulty ruling out a concomitant rotator cuff tear, as active and passive shoulder abduction maneuvers are difficult to perform in the face of an acromioclavicular joint separation.

The most reliable physical examination test for acromioclavicular joint pathology is the cross-body adduction test. This test assesses the stability of the affected shoulder and should be performed by manipulating the midshaft of the clavicle rather than the acromioclavicular joint itself. The patient elevates the arm on the affected side 90°, while the examiner grasps the elbow and adducts the involved arm across the body.

Although reproduction of pain with this maneuver may occur in patients with posterior capsule tightness or subacromial impingement, pain is suggestive of acromioclavicular joint pathology. Restriction of range of motion, which is rarely associated with acromioclavicular joint pathology, more likely suggests adhesive capsulitis or glenohumeral arthritis.

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Contributor Information and Disclosures
Author

Brett D Owens, MD Professor of Surgery, F Edward Hebert School of Medicine, Uniformed Services University of Health Sciences; Assistant Professor of Orthopedic Surgery, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Chief of Orthopedic Surgery, Keller Army Hospital

Brett D Owens, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Orthopaedic Trauma Association, Society of Military Orthopaedic Surgeons

Disclosure: Received consulting fee from Musculoskeletal Transplant Foundation for consulting; Received consulting fee from Johnson & Johnson (MITEK) for consulting; Received royalty from SLACK Publishing for other; Received salary from American Journal of Sports Medicine for employment.

Chief Editor

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Acknowledgements

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.

Reed L Bartz, MD Consulting Staff, Division of Sports Medicine, Nebraska Orthopaedic and Sports Medicine PC

Disclosure: Nothing to disclose.

David T Bernhardt, MD Director of Adolescent and Sports Medicine Fellowship, Associate Professor, Department of Pediatrics/Ortho and Rehab, Division of Sports Medicine, University of Wisconsin School of Medicine and Public Health

David T Bernhardt, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Sports Medicine, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Lynn A Crosby, MD, FACS Chief of Shoulder Division, Professor, Department of Orthopedic Surgery, Wright State University School of Medicine

Lynn A Crosby, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American College of Sports Medicine, American College of Surgeons, American Fracture Association, American Medical Association, American Medical Tennis Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Arthroscopy Association of North America, Mid-AmericaOrthopaedicAssociation, and Orthopaedic Research Society

Disclosure: Nothing to disclose.

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.

Thomas P Goss, MD Chief of Shoulder Surgery, Professor, Department of Orthopedic Surgery, University of Massachusetts Memorial Health Care

Thomas P Goss, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Massachusetts Medical Society, and Orthopaedic Trauma Association

Disclosure: Nothing to disclose.

Robert Josey, MD Consulting Staff, Department of Orthopedic Surgery, Orthopaedic Specialists of Austin

Robert Josey, MD is a member of the following medical societies: American Medical Association, Phi Beta Kappa, and Texas Medical Association

Disclosure: Nothing to disclose.

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

Disclosure: Nothing to disclose.

Cappi Lay, MD Staff Physician, Department of Emergency Medicine, Bellevue Hospital

Disclosure: Nothing to disclose.

Pekka A Mooar, MD Professor, Department of Orthopedic Surgery, Temple University School of Medicine

Pekka A Mooar, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Brett D Owens, MD Associate Professor of Surgery, F Edward Hebert School of Medicine, Uniformed Services University of Health Sciences

Brett D Owens, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Orthopaedic Trauma Association, and Society of Military Orthopaedic Surgeons

Disclosure: Musculoskeletal Transplant Foundation Consulting fee Consulting; Johnson & Johnson (MITEK) Consulting fee Consulting; SLACK Publishing Royalty Other; American Journal of Sports Medicine Salary Employment

David Prybyla, MD Community Orthopedic Surgeon, Lowell, MA

Disclosure: Nothing to disclose.

Tom Scaletta, MD President, Smart-ER (http://smart-er.net); 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.

L Edward Seade, MD Chief of Shoulder Service, Orthopaedic Specialists of Austin

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

Russell D White, MD Professor of Medicine, Professor of Orthopedic Surgery, Director of Sports Medicine Fellowship Program, Medical Director, Sports Medicine Center, Head Team Physician, University of Missouri-Kansas City Intercollegiate Athletic Program, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center-Lakewood

Russell D White, MD, is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

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Acromioclavicular joint anatomy.
Classification of acromioclavicular joint injuries.
Allman/Rockwood classification of acromioclavicular injuries.
Anteroposterior (AP) radiograph of right shoulder showing step-off of the acromioclavicular (AC) joint.
Type III acromioclavicular joint separation.
Type III acromioclavicular joint separation.
Postoperative coracoclavicular ligament reconstruction. The clavicle is back to its normal position. The anchor in the clavicle keeps the allograft tendon from coming off of the clavicle. Also note the distal clavicle has been excised, because it had traumatic arthritis from the injury.
Type V separation, characterized by wide displacement of the clavicle in a superior direction relative to the acromion. The radiographic findings denote disruption of the acromioclavicular AC ligaments and coracoclavicular (CC) ligament, as well as the deltoid attachment to the distal clavicle.
 
 
 
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