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11-01: Acromioclavicular Joint Separation

Meghan Breed; Robert Warne Fitch

Introduction

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Degloving injury. (Photo contributor: Lawrence B. Stack, MD.)

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Video 11-01: Intro
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The authors recognize the contributions of Neha P. Raukar, George J. Raukar, and Daniel L. Savitt to previous editions.

Clinical Summary

Injury to the acromioclavicular (AC) joint usually results from an impact on the superior aspect of the acromion. The classification system includes six types: type I: stretching of the AC ligament; type II: tearing of the AC ligaments and stretching of the coracoclavicular ligaments; and types III to VI: complete disruption of the AC and coracoclavicular ligaments.

FIGURE 11.1

Shoulder Ligaments. The ligaments that stabilize the glenohumeral and acromioclavicular joints. (Reproduced with permission from The Shoulder. In: Parks E, ed. Practical Office Orthopedics. New York, NY: McGraw Hill; Copyright 2018.)

A diagram depicts the shoulder ligaments.
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Patients complain of pain at the AC joint and will actively splint the injured shoulder. Ecchymosis may be present; however, an obvious deformity is not always seen. There is significant tenderness upon AC joint palpation.

Standard radiographs should include anteroposterior (AP) and axillary lateral views of the shoulder. Type I injuries will appear normal. Type II injuries may show 0% to 50% displacement at the AC joint but no increase in the coracoclavicular interval. Types III to VI will demonstrate displacement at the AC joint and the clavicle will appear to be displaced superiorly (the acromion actually is rotated inferiorly) 50% to greater than 100% its width when compared with the normal side.

FIGURE 11.2

AC Joint Separation Types. The anatomic basis (left), clinical appearance (middle, with arrow pointing to the AC joint deformity), and x-ray findings seen with a type I, II, III, and V AC joint separation (A-C). (Reproduced with permission from The Shoulder. In: Parks E, ed. Practical Office Orthopedics. New York, NY: McGraw Hill; Copyright 2018.)

Two illustrations and an x-ray demonstrate Type 1 A C Joint Separation in the left shoulder. Two illustrations and an x-ray demonstrate Type 2 A C Joint Separation in the left shoulder. Two illustrations and an x-ray demonstrate Type 3 A C Joint Separation in the left shoulder. Two illustrations and an x-ray demonstrate Type 4 A C Joint Separation in the left shoulder.
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Two illustrations and an x-ray demonstrate Type 1 A C Joint Separation in the left shoulder. Two illustrations and an x-ray demonstrate Type 2 A C Joint Separation in the left shoulder. Two illustrations and an x-ray demonstrate Type 3 A C Joint Separation in the left shoulder. Two illustrations and an x-ray demonstrate Type 4 A C Joint Separation in the left shoulder.
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Two illustrations and an x-ray demonstrate Type 1 A C Joint Separation in the left shoulder. Two illustrations and an x-ray demonstrate Type 2 A C Joint Separation in the left shoulder. Two illustrations and an x-ray demonstrate Type 3 A C Joint Separation in the left shoulder. Two illustrations and an x-ray demonstrate Type 4 A C Joint Separation in the left shoulder.
View Full Size||Download Slide (.ppt)
Two illustrations and an x-ray demonstrate Type 1 A C Joint Separation in the left shoulder. Two illustrations and an x-ray demonstrate Type 2 A C Joint Separation in the left shoulder. Two illustrations and an x-ray demonstrate Type 3 A C Joint Separation in the left shoulder. Two illustrations and an x-ray demonstrate Type 4 A C Joint Separation in the left shoulder.
View Full Size||Download Slide (.ppt)
FIGURE 11.3

AC Joint Separation. Large deformity at the right distal clavicle suggesting complete ligament disruption. (Photo contributor: R. Jason Thurman, MD.)

A photo depicts an A C Joint Separation on a man's right shoulder. There is a deep V-shaped depression at the junction of the clavicle and shoulder.
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Video 11-02: Shoulder Exam
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Management and Disposition

Types I and II injuries are treated with rest, ice, analgesics, and a simple sling until acute pain with movement is relieved. Type III injuries may be treated either nonoperatively or operatively; however, these patients can be discharged ...

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