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Extremities Technique II > Acromioclavicular Joint > Flashcards

Acromioclavicular Joint Flashcards

1
Q

What ligaments are present in the acromioclavicular joint?

A

Acromioclavicular joint ligaments and coracoclavicular ligaments

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2
Q

Which ligaments provide the most stability to the acromioclavicular joint?

A

Coracoclavicular ligaments

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3
Q

Which ligaments provide minimal stability to ACJ?

A

Acromioclavicular joint ligaments

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4
Q

What is the most common cause of acromioclavicular joint pain?

A

Osteoarthritis

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5
Q

Osteoarthritis of the acromioclavicular joint is often caused by:

A
  • Repetitive overhead activities/work
  • Complication of acromioclavicular joint injury (trauma)
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6
Q

Who has a higher incidence of osteoarthritis of the acromioclavicular joint?

A

Heavy laborers

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7
Q

What may be found upon physical examination of osteoarthritis in the acromioclavicular joint?

A
  • Pain on palpation of AC joint
  • Pain on cross body adduction (causes compression at the ACJ)
  • Evidence of degenerative changes in the ACJ on X-ray
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8
Q

What are some methods of conservative treatment for osteoarthritis of the acromioclavicular joint?

A
  • Ice/heat
  • Mobilization/manipulation
  • Stretching
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9
Q

What sort of mobilization/manipulation is used at the AC joint when treating osteoarthritis of the AC joint?

A

A-P, P-A, S-I, and I-S glides

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10
Q

Where is mobilization/manipulation used when treating osteoarthritis of the AC joint?

A
  • AC joint
  • SCJ, GHJ, and STA
  • Cervical and thoracic spine
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11
Q

Which muscles may be stretched when treating osteoarthritis of the AC joint conservatively?

A
  • Pectoralis minor
  • Other scapular muscles
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12
Q

What are some medical managements of acromioclavicular joint osteoarthritis?

A
  • NSAIDs
  • Intra-articular corticosteroids (avoid repeated injections)
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13
Q

In a retrospective review, ___% of patients with osteoarthritis of the acromioclavicular joint failed to obtain long-term relief with steroid injection

A

81%

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14
Q

What is the most common mechanism of injury leading to AC joint sprain or separation?

A

Falling on the “point” of the shoulder

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15
Q

What can be the result of falling on the point of the shoulder?

A
  • AC joint sprain
  • AC joint separation
  • Clavicle fracture
  • SC joint dislocation
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16
Q

If a patient has the following, what is the injury?

  • Partial disruption of AC ligaments and joint capsule
  • No palpable displacement of the joint
  • If pain does not prevent assessment, there should be no hypermobility detected
A

Type I AC joint sprain

17
Q

If a patient has the following, what is the injury?

  • Ruptured AC ligament and joint capsule with partial disruption of coracoclavicular ligament
  • Distal end of clavicle may be slightly superior to the acromion on palpation
  • On stress radiographs, elevation of distal clavicle is less than the width of the clavicle but the coracoclavicular interspace is equal in both shoulders
  • If pain does not prevent assessment, hypermobility will only be present in A-P and P-A directions
A

Type II AC joint separation

18
Q

If a patient has the following, what is the injury?

  • Ruptured AC ligament, joint capsule, and coracoclavicular ligament
  • Distal end of clavicle is prominently elevated
  • On stress radiographs, elevation of distal clavicle is greater than the width of the clavicle and the coracoclavicular interspace is greater in the injured shoulder
  • If pain does not prevent assessment, global instability is present
A

Type III AC joint separation

19
Q

What is notable about a type I sprain of the AC joint?

A
  • Partial disruption of AC ligaments and joint capsule
  • No palpable displacement
  • No hypermobility
20
Q

What is notable about a type II separation of the AC joint?

A
  • Ruptured AC ligament and joint capsule with partial disruption of coracoclavicular ligament
  • Clavicle slightly superior clavicle
  • Elevation of distal clavicle less than the width of the clavicle
  • Coracoclavicular interspace is equal in both shoulder
  • Hypermobility only in A-P and P-A directions
21
Q

What is notable about a type III separation of the AC joint?

A
  • Ruptured AC ligament, joint capsule, and coracoclavicular ligament
  • Distal end of clavicle is prominently elevated
  • Elevation of distal clavicle is greater than the width of the clavicle
  • Coracoclavicular interspace is greater in injured shoulder
  • Global instability
22
Q

What is the treatment for type I AC joint sprain?

A
  • Ice and rest
  • Later strengthening exercises of trapezius and deltoid
  • Mobilization/manipulation
23
Q

What is the treatment for type II AC joint separation?

A
  • Same as type I (ice, rest, strengthening exercises)
  • Brace to depress the clavicle and reduce dislocation may be used
  • Gentle ROM can begin 48 hours post-injury
24
Q

In type I and II separations of the AC joint, residual pain may be present after healing has occurred, which can be treated with ___

A

mobilization/manipulation

25
Q

What other joints should be assessed for dysfunction if there has been a separation of the acromioclavicular joint?

A
  • SCJ
  • GHJ
  • STA
  • Cervical spine
  • Thoracic spine
26
Q

What is the treatment of type III AC joint separation?

A

Same as type II
Surgery may be needed but is rare

27
Q

What is type IV separation of the AC joint?

A

Posterior displacement of clavicle into trapezius muscle

28
Q

What is type V separation of the AC joint?

A

Severe type III injuries (greater separation)

29
Q

What is type VI separation of the AC joint?

A

Inferior displacement of clavicle into coracoid

30
Q

What type of separation has occurred if there is posterior displacement of the clavicle into the trapezius muscle?

A

Type IV separation of the AC joint

31
Q

What type of separation has occurred if there is inferior displacement of the clavicle into the coracoid?

A

Type VI separation of the AC joint

32
Q

What is the term for a severe type III AC joint injury?

A

Type V separation of the AC joint

33
Q

Which types of acromioclavicular joint separation require surgical treatment?

A

Types IV, V, and VI

Extremities Technique II (8 decks)

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