Acromioclavicular joint injuries

Outline
● Anatomy
● Mechanism
● Classification
● Clinical presentation
● Management
● Atypical synovial joint
● Acromioclavicular ligament
● Coracoclavicular ligament- conoid and trapezoid
● Nerve supply- suprascapular nerve
● Movements- passive- muscles which move the scapula
cause it to move on the clavicle
● Scapular movements on the chest wall-
protraction/retraction, elevation/depression, rotation
● Stability- coracoclavicular ligament
 Mechanism
● Acute injury- direct trauma
● Fall on the shoulder with the arm adducted- strain/
tear AC ligament- upward subluxation of the clavicle
● Severe force- coracoclavicular ligament may be torn
● Complete dislocation of the joint

● Associated injuries to nearby structures- tears to

clavicular attachments of deltoid, trapezius muscles
● Fracture to acromion, clavicle, coracoid
 Classification
● Rockwood classification
● Graded according to type of ligament injury
● Amount of displacement of the joint
 Type 1
● Sprained AC joint
 Type 2
● Torn AC ligament
● CC ligament intact
● Joint subluxated
 Type 3
● AC and CC ligaments torn
● Joint is dislocated
● Visible, palpable step
 Type 4
● Clavicle is displaced posteriorly into trapezius
 Type 5
● Clavicle is markedly elevated- gross separation
● More then double normal
 Type 6
● Inferior displacement of clavicle
● Under the coracoid and behind the conjoint tendon
 Clinical findings
● pain
● AC joint or lateral clavicle tenderness
● Abnormal contour of shoulder compared to
contralateral side
● mobile distal clavicle
 imaging
Radiographs
● Bilateral AP view- to compare displacement
with contralateral side
● Zanca view
x ray beam is tilted 10- 15 degrees towards
cephalic direction- using only 50% of the
standard penetration strength
 Treatment
● Non surgical for type 1
● Analgesia, immobilize with a sling, early range
of motion exercises
● Type 2, similar as type 1.
● Immobilization for 2- 3 weeks
● Avoid contact sports / heavy lifting for 6 weeks
● Type 3
● Option of non surgical and surgical
● Most are managed non operatively unless – athletes that
undertake contact sports/ throwing or necessary
● Type 4, 5 and 6- ORIF/ ligament reconstruction
● Rehab- sling immobilization for 6 weeks
No shoulder ROM for 6 weeks and return to full activity in 6
months
 Surgical options
● Acromioclavicular reduction and fixation
● Acromioclavicular reduction, coracoclavicular
ligament repair, and coracoclavicular fixation
● Combination of the first 2
● Distal clavicle excision
Surgical procedures for AC dislocation should
fulfill 3 requirements
1. AC joint must be exposed and debrided
2. CC or AC ligaments must be repaired or
reconstructed
3. stable reduction of the AC joint must be
obtained
AC joint reduction and transarticular wire
fixation
ORIF with CC screw fixation
ORIF with hook plate
CC ligament reconstruction
Lateral end of clavicle is excised
Acromial end of AC ligament is detached
Fastened to the lateral end of clavicle
Tension at the ligament is lessened with a sling passed
around clavicle and coracoid process
CC ligament reconstruction with free
tendon graft
● Anatomic reconstruction of both conoid and trapezoid
ligaments
● Distal clavicle resection is performed
● Autologous semitendonosus graft is used
● Figure of eight passage of graft from distal clavicle to
coracoid
● Reinforced with suture tape