Acromioclavicular joint injuries often result from sports activities or trauma and can cause problems with shoulder stability and shoulder.They can range from mild sprains to severe dislocations, which means that a different treatment approach is needed to restore functionality while reducing the risk of complications.
The acromioclavicular joint is located where the collarbone meets the highest point of the scapula (acromion). It plays a key role in allowing movement of the arm over the head and throughout the body. Acromioclavicular joint injuries are classified by severity and the structures involved, ranging from Type I to Type VI, according to the Rockwood classification system.
Common types of acromioclavicular joint injuries
Type I: Mild sprain of the ligaments of the acromioclavicular joint without displacement of the clavicle.
Type II: Involves rupture of the acromioclavicular ligaments and possible partial rupture of the coracromioclavicular ligaments, resulting in slight displacement.
Type III: Both the acromioclavicular and caracromial ligaments are completely ruptured, causing a marked displacement of the clavicle.
Types IV to VI are less frequent and involve displacement of the clavicle to varying degrees and positions, and more aggressive treatment is usually necessary.
How are injuries to the acromioclavicular joint caused
Acromioclavicular joint injuries usually result from:
- Direct impact, such as a fall directly on the shoulder, which often occurs in contact sports. If the force applied is too great, it may drive the acromion downward, overriding the ligaments.
- Indirect force, such as a fall on an outstretched arm which can cause a load up the arm and collarbone, loading the acromioclavicular joint from a different angle.
- Chronic stress on the joint from activities such as weightlifting or due to work can result in gradual degeneration of the ligaments.
Symptoms and diagnostic process
Acromioclavicular joint injuries are not always accompanied by clear symptoms as many of them mimic the symptoms of other orthopedic conditions. Typical symptoms include:
- Pain and tenderness locally, becoming more pronounced at the junction of the acromion and clavicle.
- Swelling and bruising that occurs quickly after the injury.
- Visible deformity, particularly in more severe cases, where the clavicle may appear hyperextended.
- Limited range of motion, especially in overhead movements or when patients try to move the arm across the body.
To accurately diagnose acromioclavicular joint injuries, a physical examination that includes specific maneuvers to evaluate the stability and integrity of the joint, and taking x-rays to evaluate displacement in the joint, is necessary. An MRI or ultrasound may also be needed to evaluate any soft tissue damage.
How are injuries to the acromioclavicular joint treated?
Treatment of acromioclavicular joint injuries depends on the type and severity of the injury, with the goal of reducing pain, facilitating healing and restoring function. Treatments can be either conservative and/or surgical.
Non-surgical options
For injuries that fall into categories I and II, and occasionally category III, conservative treatment options are often sufficient. Conservative treatments may include:
- Rest and application of ice to reduce swelling.
- Immobilization of the arm to facilitate healing of the joint.
- Medication to manage pain and reduce inflammation.
- Physiotherapy program to restore mobility and strengthen the shoulder muscles.
Surgical options
Surgery is the most appropriate option for severe injuries (type IV-VI) and some type III injuries, depending on the patient's activity level and functional needs. Surgical options may include:
- Open reduction and internal fixation (ORIF), in which a material is placed to stabilize the joint and facilitate healing.
- Joint/ligament reconstruction using grafts.
- Seldom excision of part of the clavicle to avoid painful contact with the acromion.
Rehabilitation and recovery
After treatment, whether by surgery or conservative means, patients follow a physical therapy program to gradually increase range of motion and strengthen the shoulder muscles. The timeline for rehabilitation varies and usually ranges from a few weeks for minor injuries to 2-3 months for more serious injuries treated surgically.
To find out more about acromioclavicular joint injuries and ways to treat them, contact us at 6943903343 (secretariat) or 6949196061 (doctor) and at orthopedikos-papagiannopoulos.gr and make an appointment.
