Have you felt severe pain in your shoulder after a fall? It can be an acromioclavicular dislocation. This injury is common and affects the joint between the collarbone and the acromion. It can cause pain, swelling, tenderness, and difficulty moving the shoulder.
The acromioclavicular joint allows for significant movements. The ligaments involved are the superior and inferior acromioclaviculars, and the coracoclavicular. A hard fall or blow can stretch or tear these ligaments, causing the injury.
This injury is common in contact athletes and with sudden movements. It is classified into degrees according to severity. Grade I is when ligaments are stretched but not torn. Grade III is when the ligaments are completely torn.
If you have an acromioclavicular dislocation, you’ll feel shoulder pain and swelling. You will also feel sensitivity and your movement will be limited. The diagnosis is made with a physical exam and imaging studies.
Treatment varies depending on the injury. It can be conservative or surgical. Recovery time depends on the severity of the injury.
If you play contact sports, it’s important to strengthen your muscles. You should also use proper techniques and protection. A proper rehabilitation program can help you regain shoulder function.
What is Acromioclavicular Dislocation?
Acromioclavicular dislocation, or “shoulder apart,” is an injury to the joint between the collarbone and shoulder blade. It occurs when the ligaments that join these bones are stretched or torn. This causes an abnormal separation between them.
Causes and Mechanisms of Injury
The most common causes include:
- Direct falls over the shoulder
- Severe blows to the shoulder during sports activities or accidents
- Sudden or violent arm movements
- Wear or weakening of the acromioclavicular ligaments
Degrees of Acromioclavicular Dislocation
Dislocation is classified into degrees according to the injury:
- Grade I (mild): Simple stretching of the acromioclavicular ligaments, with no actual separation.
- Grade II (moderate): Rupture of the acromioclavicular ligaments and stretching of the coracoclavicular ligaments.
- Grade III (severe): Complete rupture of the acromioclavicular and coracoclavicular ligaments, with visible deformity in the upper shoulder.
Symptoms and Clinical Signs
The main symptoms are:
- Sharp, severe pain in the shoulder
- Swelling and tenderness in the acromioclavicular joint
- Limitation of shoulder movement
- Possible visible deformity in the upper shoulder, especially in the most severe degrees of dislocation
If you think you’ve had an acromioclavicular dislocation, seek medical attention. This will allow you to receive a proper diagnosis and treatment.
Diagnosis and Evaluation of the Injury
The diagnosis of acromioclavicular dislocation begins with a detailed examination by a specialist. The joint is felt carefully, which helps detect pain. Shoulder movement is also measured and tests are done to see stability.
Physical Examination and Specific Tests
The most important tests are:
- Adduction test against resistance: Sensitivity of 77% and specificity of 79%.
- Active compression test (O’Brien test): Sensitivity of 41% and specificity of 95%.
- Arm extension test against resistance: Specificity of 85% and sensitivity of 72%.
- Paxinos Test: Sensitivity of 82%.
These tests help to know the degree of damage to the ligaments and the severity of the injury.
Imaging Studies: X-ray, Ultrasound and Magnetic Resonance Imaging
Several imaging tests are used to confirm the diagnosis. A shoulder X-ray shows if the collarbone and acromion are separated. Sometimes, a special screening is needed to see better.
Shoulder ultrasound helps to see the soft tissues and follow the injury. The MRI gives a detailed picture of the joint and ligaments. This way you can see damage that is not seen in other tests.
An accurate diagnosis and thorough evaluation are key to treating acromioclavicular ligament injury well. This helps the patient recover as well as possible.
Treatment of Acromioclavicular Ligament Injury
Treatment of acromioclavicular dislocation varies depending on the severity of the injury. For grades I and II, conservative treatment is sufficient. This includes rest, slinging, icing, and pain medication.
Physical therapy is crucial in recovery. It helps restore mobility and strengthen muscles. Several phases are followed, from protection to muscle strengthening.
In more severe cases (IV, V and VI), surgery may be necessary. This is done to improve the stability of the joint. Modern surgical techniques offer good results, with a success rate of 96-100% in the acute phase.
Recovery time varies depending on the severity of the injury. In general, it takes several weeks to months. After 3 weeks, 80% of patients already feel better.
Grade III injuries can cause persistent pain in 80% of cases. Rehabilitation and muscle strengthening are essential for a full recovery.
