Acromioclavicular Joint Flashcards
What ligaments are present in the acromioclavicular joint?
Acromioclavicular joint ligaments and coracoclavicular ligaments
Which ligaments provide the most stability to the acromioclavicular joint?
Coracoclavicular ligaments
Which ligaments provide minimal stability to ACJ?
Acromioclavicular joint ligaments
What is the most common cause of acromioclavicular joint pain?
Osteoarthritis
Osteoarthritis of the acromioclavicular joint is often caused by:
- Repetitive overhead activities/work
- Complication of acromioclavicular joint injury (trauma)
Who has a higher incidence of osteoarthritis of the acromioclavicular joint?
Heavy laborers
What may be found upon physical examination of osteoarthritis in the acromioclavicular joint?
- 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
What are some methods of conservative treatment for osteoarthritis of the acromioclavicular joint?
- Ice/heat
- Mobilization/manipulation
- Stretching
What sort of mobilization/manipulation is used at the AC joint when treating osteoarthritis of the AC joint?
A-P, P-A, S-I, and I-S glides
Where is mobilization/manipulation used when treating osteoarthritis of the AC joint?
- AC joint
- SCJ, GHJ, and STA
- Cervical and thoracic spine
Which muscles may be stretched when treating osteoarthritis of the AC joint conservatively?
- Pectoralis minor
- Other scapular muscles
What are some medical managements of acromioclavicular joint osteoarthritis?
- NSAIDs
- Intra-articular corticosteroids (avoid repeated injections)
In a retrospective review, ___% of patients with osteoarthritis of the acromioclavicular joint failed to obtain long-term relief with steroid injection
81%
What is the most common mechanism of injury leading to AC joint sprain or separation?
Falling on the “point” of the shoulder
What can be the result of falling on the point of the shoulder?
- AC joint sprain
- AC joint separation
- Clavicle fracture
- SC joint dislocation
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
Type I AC joint sprain
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
Type II AC joint separation
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
Type III AC joint separation
What is notable about a type I sprain of the AC joint?
- Partial disruption of AC ligaments and joint capsule
- No palpable displacement
- No hypermobility
What is notable about a type II separation of the AC joint?
- 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
What is notable about a type III separation of the AC joint?
- 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
What is the treatment for type I AC joint sprain?
- Ice and rest
- Later strengthening exercises of trapezius and deltoid
- Mobilization/manipulation
What is the treatment for type II AC joint separation?
- 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
In type I and II separations of the AC joint, residual pain may be present after healing has occurred, which can be treated with ___
mobilization/manipulation
What other joints should be assessed for dysfunction if there has been a separation of the acromioclavicular joint?
- SCJ
- GHJ
- STA
- Cervical spine
- Thoracic spine
What is the treatment of type III AC joint separation?
Same as type II
Surgery may be needed but is rare
What is type IV separation of the AC joint?
Posterior displacement of clavicle into trapezius muscle
What is type V separation of the AC joint?
Severe type III injuries (greater separation)
What is type VI separation of the AC joint?
Inferior displacement of clavicle into coracoid
What type of separation has occurred if there is posterior displacement of the clavicle into the trapezius muscle?
Type IV separation of the AC joint
What type of separation has occurred if there is inferior displacement of the clavicle into the coracoid?
Type VI separation of the AC joint
What is the term for a severe type III AC joint injury?
Type V separation of the AC joint
Which types of acromioclavicular joint separation require surgical treatment?
Types IV, V, and VI
