AC Joint injuries Senarios

Question 1

Mechanical SX

Answer 1

Popping, catching or grinding

Question 2

Aggravating and Alleviating

Answer 2

1. Pain increased when reaching across body

Question 3

Look

Answer 3

1. Appropriately disrobed (watch how they disrobe)
2. A trophy

infraspinatous

supraspinatus

Question 4

Special Tests

Answer 4

1. Impingement
2. Rotator cuff lag signs
3. Instability
4. AC joint
5. Biceps tendonitis
6. SLAP
7. C-spine
8. Thoracic outlet

Question 5

AC joint Exam

Answer 5

1. Scarf test
   
   1. Pain with involved hand on contralateral shoulder and resisted elbow elevation (relief with lidocaine)
2. Resisted cross-body adduction
3. Passive cross-body adduction

Question 6

Imaging

Answer 6

1. Glenohumeral AP (45 degrees = in plane of scapula)
2. axillary view
3. scapular Y view
4. Zanca view for AC jt
5. AP coronal 30 degree caudal tilt view
6. Classification (Rockwood)

Type 1

AC sprain

Type 2

< 25% increased coraclavicular space compared to normal – superior displacement

AC rupture, CC intact

Type 3

25 – 100% increased coracoclavicular space compared to normal – superior displacement

AC and CC rupture

Type 4

posterior clavicle displacement through trapezius

Type 5

100 – 300% increased coracoclavicular space compared to normal – superior displacement

Rupture of deltotrapezial fascia

Type 6

clavicle displaced under acromion - subacromial or under coracoid – subcoracoid - inferior

Question 7

Zanca view for AC jt

Answer 7

1. AP coronal 10-30 degrees cephalic tilt centered on AC jt
2. Cystic/degenerative changes at distal end of clavicle suggest AC pathology

Question 8

Diagnosis or DDx

Answer 8

1. Fractures
2. Dislocations
3. AC Joint arthritis – osteoarthritis or posttraumatic
4. Distal Clavicle Osteolysis
   
   1. weightlifters
   2. activity modification
   3. OR – distal clavicle excision

Question 9

Type 1 (AC sprain)

Answer 9

1. Treat with RICE and sling for comfort
2. Early ROM and rehab
3. Heavy lifting and sports when asymptomatic – usually 2 weeks
4. Persistent pain
   
   1. NSAIDs, rest, activity modification, physio
5. Operative:
   
   1. Late AC arthritis
   2. Failed 6 months of non-operative treatment
   3. Inject AC joint with 2-3cc 1% lidocaine and document resolution of symptoms
      
      1. Arthroscopic distal clavicle excision

Question 10

Type 2 (AC torn, CC sprain)

Answer 10

1. Treat with RICE and sling for comfort
2. Early ROM and rehab
3. Heavy lifting and sports start at 6 weeks
4. Persistent pain
   
   1. NSAIDs, rest, activity modification, physio
5. Operative
   
   1. Late AC arthritis
   2. Failed 6 months of non-op treatment
   3. Inject AC joint with 2-3cc 1% lidocaine and document resolution of symptoms
      
      1. coracoclavicular distance
         
         1. Normal
            
            1. Arthroscopic distal clavicle resection if AC arthritis
         2. Increased

Open chronic AC reconstruction + distal clavicle resection

Question 11

Type 3 (AC torn, CC torn, delto-trapezial fascia injured)

Answer 11

1. Treat with RICE and sling for comfort x 4 – 6weeks
2. Early ROM and rehab
3. Strengthening when 85% return of ROM – usually at 4 weeks
4. Return to sports and lifting at 3 – 4 months
5. Persistent pain
   
   1. NSAIDs, rest, activity modification, physio
6. Operative
   
   1. Indications for acute Sx treatment
      
      1. high-level pitchers / overhead athletes with dominant arm injury
      2. manual laborers
      3. open injuries
      4. brachial plexopathy
      5. Treatment
         
         1. Acute AC joint reconstruction
   2. Late AC arthritis
   3. Failed 6 months of non-op treatment
   4. Inject AC joint with 2-3cc 1% lidocaine and document resolution of symptoms

• Chronic AC ligament reconstruction +/- distal clavicle resection

Question 12

Physio

Answer 12

1. Sling for 6 weeks – ADLs ok but no forward flexion, abduction, or lilfting
2. At 3 weeks
   
   1. start pendulum and passive ER exercises, continue abduction sling outside of physio
3. At 6 weeks
   
   1. active, active assisted, and passive ROM started AFTER screw is removed under local anesthesia (acute repair)
4. Resistive exercises at 3 months
5. Start strengthening when ROM 85% of normal side (usually 12 weeks)
6. Return to sports at 6 months when strength testing almost equal to other side