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Ac Joint Injuries: Anand Vichyanond, MD

1. AC joint injuries can occur from direct force to the shoulder or falling on the lateral aspect of the adducted shoulder. 2. Rockwood classified AC joint injuries into 6 types based on the amount of ligament damage and degree of displacement. Types I and II are minor sprains while types IV, V and VI involve greater displacement. 3. Treatment depends on injury type. Types I and II are treated non-operatively with immobilization and pain management. Types IV, V and VI require open reduction and stabilization surgery. Treatment for type III injuries is controversial but often non-operative initially.

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65 views20 pages

Ac Joint Injuries: Anand Vichyanond, MD

1. AC joint injuries can occur from direct force to the shoulder or falling on the lateral aspect of the adducted shoulder. 2. Rockwood classified AC joint injuries into 6 types based on the amount of ligament damage and degree of displacement. Types I and II are minor sprains while types IV, V and VI involve greater displacement. 3. Treatment depends on injury type. Types I and II are treated non-operatively with immobilization and pain management. Types IV, V and VI require open reduction and stabilization surgery. Treatment for type III injuries is controversial but often non-operative initially.

Uploaded by

Sitthikorn Strikerr
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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AC joint INJURIES

Anand Vichyanond, MD
SIRIRAJ
Anatomy

• AC ligament
– Horizontal stability
• CC ligament
– Vertical stability
• Deltoid & Trapezius
Anatomy

• Diarthrodal joint
• Hyaline cartilage – Covered convex lateral clavicle
• Concave medial acromion
• Fibrocartilagenous disc
Mechanism of injury

• Direct force
– Fall on the lateral aspect of the adducted shoulder
Associated injuries

• Scapulothoracic dissociation
• Fractures
• Brachial plexus injury
• Osteolysis of distal clavicle
Rockwood’s Classification
• According to the amount of injury to the AC and CC ligaments
Physical Examinations
: According to classifications
• Type I
– Sprain AC : pain, tender &
swelling
– No instability

• Type II
– Pain & tender on both AC
& CC
– Displacement < 25%
– AP instability
Physical Examinations
: According to classifications
• Type III
– Droopy shoulder
– Held in Add & elevation
– Prominent distal clavicle
– Reducible !!!

• Type IV
– Posterior incling distal
clavicle
– Tenting posterior skin
– Asso. :Ant’ SC dislocation
Physical Examinations
: According to classifiactions
• Type V
– Gross sup’ displacement of
dis.Clavicle and tenting
skin
– Displacement 100-300%
– Asso : Traction BPI

• Type VI
– Rare
– Flat sup’ shoulder,
prominent acromion
Plain film
• Bilateral Zanca view
• Transaxillary view
• Stryker notch view R/O coracoid fracture
Zanca view
• AC joint
• Overlapping of the spine of sacpula
• 10-15 degree cephalic tilt
Transaxillary view
• Posterior displacement
• Type IV
Stress film
True AP film
Treatment
• Very little controversy
– Type-I and II injuries
– Type-IV and V injuries
• Type-III injuries
– Controversial
– No general consensus
Acute Type I & II Injuries
• Non-operative treatments
– Sling immobilization, strapping in type II
– Symptomatic treatment of pain
– Activites are resumed as tolerated (1-2 wks)
• Late consequence
– Posttraumatic osteolysis of the clavicle
– Posttraumatic arthritis
– Recurrent instability
• Rx – Dist. Clavicle resection with capsular
plication with ligament reconstruction
Type III injuries
: Most controversy
• Generally : Non-operative
• RW 7th Authors’ Preferred Treatment
: Operative stabilization
- Heavy manual labour
- Pts with concomitant BPI
- Overhead athletes
- Dominant arm
- Polytrauma patient
Type IV, V, VI Injuries
• Open reduction and stabilixation
1. Intra-articular AC fixation
- small, smooth or threaded Steinmann pins
- Hool plate
2. Extra-articular CC repair
- Bosworth screw, cerclage Dacron ligament, Suture
anchor and Tightrobe
3. Ligament reconstruction in chronic
- Weaver Dunn
- Anatomic Semi-T graft : most strongest
- Distal clavicle excision used in chronic case related
with symptom or OA change
Treatment

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