ACROMIO-CLAVICULAR INJURIES

Question 1

Definition

Answer 1

Aka shoulder separation
Traumatic injury to AC joint with disruption of the AC and/or CC ligaments

Question 2

Mechanism

Answer 2

Fall on shoulder tip with arm adducted

Question 3

Physical Exam

Answer 3

Tender and deformity of the AC joint
Assess anterior - posterior stability
Assess superior-inferior stability
Scarf Test
AC Joint Distraction Test

Question 4

X-RAY

Answer 4

AC Radiographs AP Views
Axillary Lateral Views
Zanca Views

Question 5

Classification of Acromioclavicular Joint Injuries

Answer 5

Grade 1 - 6

Question 6

Type I: Mechanism, Physical and X-RAY findings

Answer 6

Sprained AC Ligaments
Radiograph: Normal
Exam: Tenderness over AC joint

Question 7

Type II: Mechanism, Physical and X-RAY findings

Answer 7

AC Ligaments ruptured, CC ligaments sprained
Radiograph: Slight widening of AC joint, clavicle elevated 25-50% above acromion
Exam: Tenderness and mild step off deformity of AC joint

Question 8

Type III: Mechanism, Physical and X-RAY findings

Answer 8

AC and CC ligament ruptured
X-RAY: clavicle 100% above acromion, CC space widened 25%-100%
Exam: Distal end of clavicle prominent, shoulder droops

Question 9

Indications of emergent orthopedic consultation

Answer 9

Open fracture
Neurovascular injuries
Persistent skin tenting

Question 10

Management: Grade I & II

Answer 10

sling
Rest
Ice
early range of motion exercises (7 to 10 days)
follow up with PCP

Question 11

Management: Grade III

Answer 11

Sling and ortho follow up