AC INJURY

Question 1

Results from

Answer 1

a fall onto the tip of the shoulder resulting in variable degrees of
ligamentous disruption.

Question 2

six types of Acromioclavicular (AC) Injury

Answer 2

based on severity of injury and degree of clavicular separation
(a) Type I: Acromioclavicular (AC) ligaments partially disrupted and
Coracoclavicular (CC) ligaments are intact. No superior separation of
clavicle from acromion.
(b) Type II: AC ligaments are torn and CC ligaments are intact
resulting in partial separation of the clavicle from acromion.
(c) Type III: AC and CC ligaments are completely disrupted resulting I complete
separation of the clavicle from acromion.
(d) Type IV: AC and CC ligaments are completely disrupted with superior and
prominently posterior displacement.
(e) Type V: AC and CC ligaments are completely disrupted with CC interspace
more than twice as large as opposite shoulder.
(f) Type VI: Uncommon. Clavicular periosteum and/or deltoid and trapezius
muscle are torn resulting in wide displacement. Clavicle lies in either the subacromial space or subcoracoid space.

Question 3

Clinical Symptoms of Acromioclavicular (AC) Injury

Answer 3

(1) Pain over AC joint
(2) Pain on lifting affected arm
(3) Type III-VI presents with obvious deformity

Question 4

Physical Exams of Acromioclavicular (AC) Injury

Answer 4

(1) Inspection
(a) Patient supports arm in adducted position
(b) Distal clavicle prominent and superior to acromion with Type II injuries
(2) Palpation
(a) Tenderness to AC joint
(3) ROM
(a) Full ROM. Any motion, especially abduction, causes pain
(b) Elevating arm or depressing the clavicle will temporarily reduce the AC
joint except in type IV and V injuries
(4) Muscle Tests
(a) Decreased general muscle strength due to pain
(5) Neurovascular Tests
(a) Typically unremarkable unless an injury to the brachial plexus “stinger” is
present
(6) Special Tests
(a) Any motion of the shoulder causes pain

Question 5

Diagnostic Tests of Acromioclavicular (AC) Injury

Answer 5

(1) Anterior-posterior (AP) and axillary radiographs of bilateral shoulders confirm type
II -VI AC separations
(2) Type I radiographs are negative and primarily diagnosed with clinical presentation
and history

Question 6

Adverse Outcomes of Acromioclavicular (AC) Injury

Answer 6

(1) Deformity
(2) Weakness
(3) Chronic shoulder pain
(4) AC arthrosis

Question 7

Treatment of Acromioclavicular (AC) Injury

Type I and II:

Answer 7

(a) Sling x 24-48 hours
(b) Ice
(c) Analgesics
(d) Home exercise program that focuses on ROM and general shoulder
strengthening
(e) Return to full duty as pain permits, usually within 4 weeks

Question 8

Treatment of Acromioclavicular (AC) Injury

Type III:

Answer 8

(a) Controversial for non-surgical vs surgical intervention
(b) Orthopedic consultation
(c) Sling x 24-48 hours
(d) Ice
(e) Analgesics
(f) Home exercise program that focuses on ROM and general shoulder
strengthening
(g) Light duty until evaluation by orthopedics

Question 9

Treatment of Acromioclavicular (AC) Injury

Type IV-VI:

Answer 9

(a) Orthopedic consultation, will require surgery
(b) Sling until evaluated by orthopedics
(c) Ice
(d) Analgesics
(e) Light duty until evaluation by orthopedics
(f) MEDEVAC

Question 10

Referral Outcomes/Red Flags of Acromioclavicular (AC) Injury

Answer 10

(1) Type III-VI injuries require orthopedic consultation

(2) Injuries that remain painful warrant further evaluation