AC Joint Injuries

Question 1

How to AC injuries happen?

Answer 1

1. From a fall or hit to the shoulder (direct blow to adducted shoulder

Question 2

What are types I and II?

Answer 2

I: AC ligament injury, no CC injury (no clavicle elevation)
II: AC ligament torn, CC ligament partially torn, partial AC separation (under stress, possibly not under stress)

Question 3

What is type III and IV,V, VI?

Answer 3

III: AC ligament torn, CC ligament torn, complete separation of clavicle from acromion
IV, V, VI: rare wider displacement involves tearing of periosteum and musculature around clavicle

Question 4

During the PE what will you find?

Answer 4

1. Pain with lifting arm
2. Unable to lift arm at shoulder
3. Palpation is sore over AC joint
4. Arm elevation or clavicle depression for reducing

Question 5

What diagnostic tests should you run?

Answer 5

1. AP X-ray of both shoulders no same view
2. Stress views (hold weight in hands)

Question 6

What are the adverse outcomes of an AC injury?

Answer 6

1. Deformity
2. Weakness
3. Chronic pain
4. Numbness in arm
5. AC joint arthritis

Question 7

What is the treatment for type I and II?

Answer 7

1. Sling until comfortable (not long, as shorter as possible)
2. Ice
3. Analgesics
4. Return to activity as tolerated

Question 8

What is the treatment for type III?

Answer 8

1. Surgery
   *dependent on age and occupation

Question 9

What is the treatment for type IV-VI?

Answer 9

1. Surgery

Question 10

When would you refer to ortho?

Answer 10

Type III-VI for evaluation for possible surgical treatment
*but can refer all to ortho for follow up