Shoulder AC injury

Question 1

What degree of Clavicular separation
Acromioclavicular (AC) ligaments partially disrupted and Coracoclavicular (CC) ligaments are intact. No superior separation of clavicle from acromion.

Answer 1

Type I

Question 2

What degree of Clavicular separation
AC ligaments are torn and CC ligaments are intact resulting in partial separation of the clavicle from acromion.

Answer 2

Type II

Question 3

What degree of Clavicular separation
AC and CC ligaments are completely disrupted resulting I complete separation of the clavicle from acromion.

Answer 3

Type III

Question 4

What degree of Clavicular separation
AC and CC ligaments are completely disrupted with superior and prominently posterior displacement

Answer 4

Type IV

Question 5

What degree of Clavicular separation
AC and CC ligaments are completely disrupted with CC interspace more than twice as large as opposite shoulder

Answer 5

Type V

Question 6

What degree of Clavicular separation
Uncommon. Clavicular periosteum and/or deltoid and trapezius muscle are torn resulting in wide displacement. Clavicle lies in either the subacromial space or subcoracoid space.

Answer 6

Type VI

Question 7

How does an AC injury happen

Answer 7

Results from a fall onto the tip of the shoulder resulting in variable degrees of ligamentous disruption.

Question 8

What DX
Clinical Symptoms
-(1) Pain over AC joint
-(2) Pain on lifting affected arm
-(3) Type III-VI presents with obvious deformity
Physical Exams
(1) Inspection
-(a) Patient supports arm in adducted position
-(b) Distal clavicle prominent and superior to acromion with Type II injuries
–(2) Palpation
—-(a) Tenderness to AC joint
–(3) ROM
—-(a) Full ROM. Any motion, especially abduction, causes pain
—-(b) Elevating arm or depressing the clavicle will temporarily reduce the AC
joint except in type IV and V injuries
–(4) Muscle Tests
—-(a) Decreased general muscle strength due to pain
–(5) Neurovascular Tests
—-(a) Typically unremarkable unless an injury to the brachial plexus “stinger” is present
(6) Special Tests
—-(a) Any motion of the shoulder causes pain

Answer 8

Acromioclavicular (AC) Injury

Question 9

Type I radiographs are ______ and primarily diagnosed with clinical presentation and history

Answer 9

negative

Question 10

Anterior-posterior (AP) and axillary radiographs of bilateral shoulders confirm type ___ - ____ AC separations

Answer 10

II - VI

Question 11

Treatment
Type I and II AC sep

Answer 11

(a) Sling x 24-48 hours
(b) Ice
(c) Analgesics
(d) Home exercise program that focuses on ROM and general shoulder strengthening
(e) Return to full duty as pain permits, usually within 4 weeks

Question 12

Treatment
Type III

Answer 12

(a) Controversial for non-surgical vs surgical intervention
b) Orthopedic consultation
(c) Sling x 24-48 hours
(d) Ice
(e) Analgesics
(f) Home exercise program that focuses on ROM and general shoulder strengthening
(g) Light duty until evaluation by orthopedics

Question 13

Treatment
Type IV-VI AC Separation

Answer 13

(a) Orthopedic consultation, will require surgery
(b) Sling until evaluated by orthopedics
(c) Ice
(d) Analgesics
(e) Light duty until evaluation by orthopedics
(f) MEDEVAC

Question 14

Referral Outcomes/Red Flags AC Sep

Answer 14

(1) Type III-VI injuries require orthopedic consultation
(2) Injuries that remain painful warrant further evaluation