Acromioclavicular Joint Injury Treatment & Management

  • Author: L. Edward Seade, MD; Chief Editor: Craig C Young, MD   more...
 
Updated: Dec 5, 2011
 

Acute Phase

Rehabilitation Program

Physical Therapy

Acromioclavicular joint injuries are painful and the patient often lacks full range of motion after the injury. Physical therapy plays a role in the treatment of these patients. The author routinely starts therapy within the first couple of weeks in acromioclavicular joint sprains.

For fractures of the acromioclavicular joint, wait until evidence of healing is apparent either clinically or radiographically before starting formal therapy. Therapy for degenerative joint disease of the acromioclavicular joint has not been proven to be successful.

Surgical Intervention

Acromioclavicular joint sprains do well with conservative management. Type I and II injuries never necessitate surgical care to reconstruct the injured ligaments. These injuries may need further care if the acromioclavicular joint becomes arthritic from the injury (see below).

Postoperative coracoclavicular ligament reconstrucPostoperative 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.

Surgical intervention may be an option in type III acromioclavicular joint sprains, but only after the patient's condition has failed a good trial of conservative treatment with physical therapy and medication. The procedure for these patients is reconstruction of the torn coracoclavicular ligaments with either local tissue or an allograft. In the past, surgeons have used screws, sutures, suture tape, synthetic grafts, and Kirschner (K)-wires to try to repair the defect. These have all fallen out of favor, and the current criterion standard is to reconstruct the torn ligaments as mentioned above.[6]

Fractures in and around the acromioclavicular joint are mostly treated conservatively in a sling. The few times surgery needs to be considered are when there is a moderate amount of displacement of the fracture fragments. Surgery is indicated for open fractures, neurovascular injury, and for those cases in which the skin is compromised and may rupture from the pressure of the prominent bone.

Injuries that lead to arthritis of the acromioclavicular joint are also treated with conservative measures first. Anti-inflammatory medication and intra-articular steroid injections work well for degenerative changes in the acromioclavicular joint. In cases that have failed conservative therapy, excision of the distal clavicle can be performed with a minimally invasive arthroscopic procedure.[7]

Consultations

If the athlete has sustained concomitant rib fractures with shortness of breath, good quality chest radiographs are indicated. A consult from a pulmonary physician or cardiovascular chest surgeon may be necessary.

Proceed to Medication
 
 
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.

Specialty Editor Board

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.

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.

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, 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, Director of Primary Care Sports Medicine Fellowship, 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, and Phi Beta Kappa

Disclosure: Nothing to disclose.

References

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

  2. Hudson VJ. Evaluation, diagnosis, and treatment of shoulder injuries in athletes. Clin Sports Med. Jan 2010;29(1):19-32, table of contents. [Medline].

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

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

  5. Nemec U, Oberleitner G, Nemec SF, Gruber M, Weber M, Czerny C, et al. MRI versus radiography of acromioclavicular joint dislocation. AJR Am J Roentgenol. Oct 2011;197(4):968-73. [Medline].

  6. Lizaur A, Sanz-Reig J, Gonzalez-Parreño S. Long-term results of the surgical treatment of type III acromioclavicular dislocations: an update of a previous report. J Bone Joint Surg Br. Aug 2011;93(8):1088-92. [Medline].

  7. DeBerardino TM, Pensak MJ, Ferreira J, Mazzocca AD. Arthroscopic stabilization of acromioclavicular joint dislocation using the AC graftrope system. J Shoulder Elbow Surg. Mar 2010;19(2 Suppl):47-52. [Medline].

  8. 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].

  9. 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].

  10. 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].

  11. 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].

  12. 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].

  13. 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].

  14. 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].

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

  16. 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].

  17. 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.

  18. 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.

  19. 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].

  20. 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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Classification of acromioclavicular joint injuries.
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.
Postoperative rehabilitation.
 
 
 
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