eMedicine Specialties > Sports Medicine > Shoulder

Acromioclavicular Joint Injury: Follow-up

Author: L. Edward Seade, MD, Chief of Shoulder Service, Orthopaedic Specialists of Austin
Coauthor(s): Reed L Bartz, MD, Consulting Staff, Division of Sports Medicine, Nebraska Orthopaedic and Sports Medicine PC; Robert Josey, MD, Consulting Staff, Department of Orthopedic Surgery, Orthopaedic Specialists of Austin
Contributor Information and Disclosures

Updated: Oct 27, 2008

Follow-up

Return to Play

The author has the following strict return-to-sports criteria that he addresses with patients who have acromioclavicular joint injuries and with physical therapists:

  • No swelling/pain with functional activity
  • Isokinetic strength that is 80% of the opposite rotator cuff
  • Full active and passive range of motion
  • Scapula is stable through full range of motion and has normal scapulohumeral rhythm
  • Pain-free activities of daily living (ADLs)


Postoperative rehabilitation.

Postoperative rehabilitation.

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Postoperative rehabilitation.

Postoperative rehabilitation.

Complications

Just like any other joint in the body, once the acromioclavicular joint has been injured, it has a tendency for arthritis and pain. The most common problem after these injuries is pain in the acromioclavicular joint. In type III sprains, the most common setback is also instability in the clavicle from the torn ligaments. 

Postoperative complications may also arise. The most common complication is mild residual instability after ligament reconstruction. This complication was more common when screws, sutures, suture tape, and K-wires were being used to repair coracoclavicular ligament tears. Infections may also occur, but these are rare, occurring less than 1% of the time. 

When a patient is dealing with an arthritic acromioclavicular joint, the most common problem is inadequate resection of the clavicle during surgery. This causes continued acromioclavicular joint pain in these patients, but it is easily fixed with proper arthroscopic resection of the fragment.

Prevention

Prevention of significant acromioclavicular joint degenerative pathology simply consists of early diagnosis of the problem and avoidance of causative maneuvers, if possible.

Prognosis

Although the literature does not contain studies investigating the natural history of acromioclavicular joint degenerative disease, some studies report that athletes with distal clavicle osteolysis often experience resolution of symptoms with avoidance of provocative activities.4,5

Published studies of patients undergoing both arthroscopic and open resection have reported good or excellent results in approximately 60-100% of cases of acromioclavicular joint injuries. No prospective comparisons of open versus arthroscopic treatment have been published; however, retrospective studies have shown similar long-term results. Patients undergoing arthroscopic treatment are likely to return to activity more quickly than other patients.7

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnose and treat a concomitant pathologic condition may be a medicolegal pitfall.
 


More on Acromioclavicular Joint Injury

Overview: Acromioclavicular Joint Injury
Differential Diagnoses & Workup: Acromioclavicular Joint Injury
Treatment & Medication: Acromioclavicular Joint Injury
Follow-up: Acromioclavicular Joint Injury
Multimedia: Acromioclavicular Joint Injury
References
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References

  1. Rockwood CA, Green DP, eds. Injuries to the acromioclavicular joint. Fractures in Adults. Philadelphia, Pa: JB Lippincott; 1984:860-91.

  2. Macdonald PB, Lapointe P. Acromioclavicular and sternoclavicular joint injuries. Orthop Clin North Am. Oct 2008;39(4):535-45. [Medline].

  3. Shaffer BS. Painful conditions of the acromioclavicular joint. J Am Acad Orthop Surg. May-Jun 1999;7(3):176-88. [Medline].

  4. Slawski DP, Cahill BR. Atraumatic osteolysis of the distal clavicle. Results of open surgical excision. Am J Sports Med. Mar-Apr 1994;22(2):267-71. [Medline].

  5. Cahill BR. Osteolysis of the distal part of the clavicle in male athletes. J Bone Joint Surg Am. Sep 1982;64(7):1053-8. [Medline]. [Full Text].

  6. Murphy OB, Bellamy R, Wheeler W, Brower TD. Post-traumatic osteolysis of the distal clavicle. Clin Orthop Relat Res. 1975;109:108-14. [Medline].

  7. Flatow EL, Duralde XA, Nicholson GP, Pollock RG, Bigliani LU. Arthroscopic resection of the distal clavicle with a superior approach. J Shoulder Elbow Surg. Jan-Feb 1995;4(1 pt 1):41-50. [Medline].

  8. Allman FL Jr. Fractures and ligamentous injuries of the clavicle and its articulation. J Bone Joint Surg Am. Jun 1967;49(4):774-84. [Medline]. [Full Text].

  9. Fukuda K, Craig EV, An KN, Cofield RH, Chao EY. Biomechanical study of the ligamentous system of the acromioclavicular joint. J Bone Joint Surg Am. Mar 1986;68(3):434-40. [Medline]. [Full Text].

  10. Le Corroller T, Cohen M, Aswad R, Pauly V, Champsaur P. Sonography of the painful shoulder: role of the operator's experience. Skeletal Radiol. Nov 2008;37(11):979-86. [Medline].

  11. Lee SJ, Keefer EP, McHugh MP, Kremenic IJ, et al. Cyclical loading of coracoclavicular ligament reconstructions: a comparative biomechanical study. Am J Sports Med. Oct 2008;36(10):1990-7. [Medline].

  12. Rolf O, Hann von Weyhern A, et al. Acromioclavicular dislocation Rockwood III-V: results of early versus delayed surgical treatment. Arch Orthop Trauma Surg. Oct 2008;128(10):1153-7. [Medline].

  13. Seade LE. Coracoclavicular ligament reconstruction with semitendinosus allograft for AC joint separations, 2-5 year follow-up. Presented at: Annual Meeting of Texas Orthopaedic Association; May 14, 2004; Austin, Texas.

  14. Seade LE. Coracoclavicular ligament reconstruction with semitendinosus allograft for AC joint separations, 2-5 year follow-up. Presented at: Western Orthopaedic Association; October 13, 2006; Santa Fe, New Mexico.

  15. Urist MR. Complete dislocation of the acromioclavicular joint: the nature of the traumatic lesion and effective methods of treatment with analysis of 41 cases. J Bone Joint Surg Am. 1946;28A:813-37. [Full Text].

  16. Zanca P. Shoulder pain: involvement of the acromioclavicular joint. (Analysis of 1,000 cases). Am J Roentgenol Radium Ther Nucl Med. Jul 1971;112(3):493-506. [Medline].

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Further Reading

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Keywords

acromioclavicular joint injury, shoulder pain, shoulder injury, shoulder dislocation, shoulder separation, acromioclavicular joint separations, dislocated shoulder, AC joint injury, AC separation, AC joint disruption, acromioclavicular disruption, shoulder joint

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Contributor Information and Disclosures

Author

L. Edward Seade, MD, Chief of Shoulder Service, Orthopaedic Specialists of Austin
Disclosure: Nothing to disclose.

Coauthor(s)

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

Medical Editor

David T Bernhardt, MD, Director of Adolescent and Sports Medicine Fellowship, Associate Professor, Department of Pediatrics, University of Wisconsin
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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Russell D White, MD, Professor of Medicine, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD, Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, 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, and Wilderness Medical Society
Disclosure: Nothing to disclose.

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