AC pathology Flashcards
AC injuries are common in
athletes
Following car accidents
Falls from bikes or during skiing
type one AC injury
Sprained AC ligaments
Normal cc ligaments
pain and swelling over a sea joint without a visible deformity
Normal radiograph
Type two AC injury
disruption of the AC ligaments
Sprained cc ligaments
Distal clavicle is unstable to horizontal stress
Pain over cc inter space
Widened AC joint and slight elevation of the clavicle on x-ray
type three AC joint injury
Disruption of the AC and CC ligaments
Distal clavicle is unstable to horizontal and vertical stress
On x-ray, moderate elevation of clavicle
type four AC injury
Posterior displacement into or through the trapezius muscle
Not reducible
X-ray axillary views show posterior displacement
type five AC injury
Rupture of the deltotrapezial fascia
clavicle palpable subcutaneously
Not reducible
Distal clavicle is elevated upon x-ray
Type six AC injury
inferior displacement of the distal clavicle under the conjoined tendon
Associated with rib, fractures, and neurovascular injury
x-ray, clavicle is in a subacromial or subcoracoid position
Type one coracoclavicular interspace distance
Normal
type two coracoclavicular interspace distance
Less than 25%
widened radiographic appearance of AC
AC painful arc
occurs in terminal abduction, more than flexion
Between 170 to 180° of elevation
Due to clavicular elevation and posterior rotation, along with posterior tilting of the scapula
ac pain also with horizontal adduction
strength and sensation for AC injuries
Often generalized weakness of the shoulder due to pain and stress
Transient paresthesia throughout upper extremity has occurred with type six
special test cluster for AC
Crossover test
Resisted extension test
O’Brien’s test
Positive for all is pain at the AC joint
Crossover test
Flex shoulder to 90° and then passively horizontally adduct to end range
resisted extension test
Flex shoulder to 90° and then resist horizontal abduction
O’Brien’s test
Flex shoulder to 90° and then horizontally adduct about 10° and internally rotate to point thumb towards the floor, then resist flexion
type one and type two management
Nonsurgical
Relative rest, ice, pain control modalities for the first 2 to 3 days
Short term, sling and immobilization until resting pain is minimal
2 days -2 weeks for type one
Up to three weeks for type two
Gentle range of motion and muscle activation as tolerated
Progress as pain improves
Functional range of motion often obtained around six weeks and full function achieved by 12 weeks
type three management
Possible return to full pain-free function without surgery, but surgery is often recommended to reconstruct the injured tissues
outcomes similar between the two treatments
Longer immobilization following surgery
type Four and five and six management
surgical management is indicated
rehab following surgery
Immobilization up to six weeks
pain relieving interventions
Gradually regain ROM and strength
Expected return to function within about six months
