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Information sheet for AC Joint Sprain
Ligaments
Superior, inferior, anterior, posterior AC ligaments = Prevents A/P shear and provides horizontal stabilisation - superior most important for stability
Coraclavicular ligaments = Conoid and Trapezoid - Resists superior and inferior translation
Rockwood Classification
Type I – mild, unseparated sprain of the AC ligaments with no disruption of the coracoclavicular ligaments. |
Type II – complete disruption of the AC ligaments with joint separation (less than 4 mm or 40% difference) and sprained but intact coracoclavicular ligaments. |
Type III – complete disruption of AC and coracoclavicular ligaments with joint separation and inferior displacement of the shoulder complex. |
Type IV – complete disruption of AC and coracoclavicular ligaments with posterior displacement of the clavicle through the fibers of the trapezius, and detachment of deltoid and trapezius muscles from the distal clavicle. |
Type V – complete disruption of the AC and coracoclavicular ligaments with significant inferior displacement of the shoulder complex from the clavicle as compared to a typical Type III injury. |
Type VI – complete disruption of the AC and coracoclavicular ligaments, and the clavicle has dislocated inferiorly, below the coracoid process. |
Mechanism of injury
- Fall onto the shoulder with arm in an adducted position |
- FOOSH/Elbow |
- Makes up 40-50% of athletic shoulder injuries at 2-4th decade of life |
- Rugby, Ice hockey, football, wrestling players are more susceptible |
Presentation
- Pain and swelling on anterosuperior aspect of the shoulder after trauma |
- Symptoms start in the traps,shoulder and neck but move to the AC joint |
- Painful with bench pressing, dips or laying on the affected side |
- Bruising/defomity on clavicular prominence |
Diagnostic findings
- Swelling, bruising and deformity on clavicular prominence |
- Tenderness over AC |
- Feeling of giving way on palpation of distal clavicle (+ve Piano Key sign) |
- ROM painful and limited - abduction most affected |
- +ve Cross body adduction |
- +ve BvR |
- +ve Paxino |
- +ve Buchberger test |
- Associated with fractured clavicle, impingement syndromes and neurovascular insults |
- Consider active vs passive ROM - Rotator cuff
- Buchberger test distinguishes subacromial impingement from AC joint sprain (more pain in external rotation)
- Evaluate entire clavicle and SC for other injuries
- Perform full neurovascular exam on affected side
DDx
- Clavicular f# |
- Rotator Cuff lesion |
- Shoulder Anterior impingement syndrome |
- Shoulder dislocation |
- Labral injury |
- Osteolysis of distal clavicle |
- Neoplasm |
- Rheumatologic disease |
- Cervical spine/viscerosomatic referral |
- Shoulder osteoarthritis |
- Adhesive Capsulitis |
- Erb Duchenne |
- Septic Arthritis |
- CRPS |
Radiographs
AP, lateral, and axillary lateral views
- Not often apparent on x-ray - Zanca view (tilting of beam 10-15 degrees caudal and bilateral AP views), weighted stress views
- MRI only used to rule out other pathologies of the shoulder
- X-ray shows AC joint separation (type 3) due to ligament injury
Management
Grade I + II - Protection, immobilisation (sling for 3-10 days), mobility and strengthening |
- Passive mobility exercises (avoid exercises that involve behind back internal rotation, crossbody adduction and forward elevation) |
- Strengthening (closed chain scapula stability exercises - scapula clocks |
- Prognosis is favourable
- Usually regains motion by six weeks and regain normal function within 12 weeks |
- Surgery for IV-VI types (six week immobilisation with up to six months recovery time) |
- AC joint arthritis and joint pain can occur in future |
- Type III-VI should have regular appointments by a orthopaedic surgeon/physician |
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