MSK - Shoulder

Question 1

What is the mechanism of action of AC joint sprain?

Answer 1

Direct impact to the shoulder or AC joint as falling or landing on your shoulder
or falling on an outstretched arm

Question 2

What is the classification of AC joint sprains/separations?

Answer 2

Rockwood classification
- 6 types
Type I and II are primary care
Type III - VI are referral for Surgery (Type III is generally conservative tx)

Type I: Sprained/intact AC + CC (AC tenderness)
Type II: disrupted AC, sprained CC (unstable to horizontal stress, x-ray will show lateral end slightly elevated)

Question 3

What to check in Physical Exam of an AC joint injury?

Answer 3

• Neurovascular (brachial plexus)
• Swelling/deformity of displaced clavicle
• palpate to r/o fracture
• cross body adduction test (chronic sprain)
• active compression test
• shoulder shrug test

Question 4

What investigations to order in an AC joint pathology?

Answer 4

X-ray - a true AP view + Tauber protocol (Xanca, axillary and dynamic lateral views) to classify and r/o #

Question 5

Management of AC joint sprain?

Answer 5

Type I and II: non-operative, sling for 2 weeks, PT, usually resolves in 6 weeks
Type III-VI: ortho referral