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% Document Info
\author{Siffi (Siffi)}
\pdfinfo{
  /Title (ac-joint-sprain.pdf)
  /Creator (Cheatography)
  /Author (Siffi (Siffi))
  /Subject (AC Joint Sprain Cheat Sheet)
}

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    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{AC Joint Sprain Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Siffi (Siffi)} via \textcolor{DarkBackground}{\uline{cheatography.com/122609/cs/25828/}}}
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\noindent
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Siffi (Siffi) \\
  \uline{cheatography.com/siffi} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 2nd November, 2021.\\
   Updated 2nd November, 2021.\\
   Page {\thepage} of \pageref{LastPage}.
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  Measure your website readability!\\
  www.readability-score.com
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\begin{document}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Ligaments}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{17.67cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/siffi_1609770501_download.jpg}}} \tn 
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Superior, inferior, anterior, posterior AC ligaments}} = Prevents A/P shear and provides horizontal stabilisation - superior most important for stability \newline {\bf{Coraclavicular ligaments}} = Conoid and Trapezoid - Resists superior and inferior translation}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Rockwood Classification}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Type I}} – mild, unseparated sprain of the AC ligaments with no disruption of the coracoclavicular ligaments.} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Type II}} – complete disruption of the AC ligaments with joint separation (less than 4 mm or 40\% difference) and sprained but intact coracoclavicular ligaments.} \tn 
% Row Count 7 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Type III }}– complete disruption of AC and coracoclavicular ligaments with joint separation and inferior displacement of the shoulder complex.} \tn 
% Row Count 10 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{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.} \tn 
% Row Count 15 (+ 5)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{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.} \tn 
% Row Count 19 (+ 4)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Type VI }}– complete disruption of the AC and coracoclavicular ligaments, and the clavicle has dislocated inferiorly, below the coracoid process.} \tn 
% Row Count 22 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Mechanism of injury}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Fall onto the shoulder with arm in an adducted position} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- FOOSH/Elbow} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Makes up 40-50\% of athletic shoulder injuries at 2-4th decade of life} \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Rugby, Ice hockey, football, wrestling players are more susceptible} \tn 
% Row Count 7 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Presentation}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Pain and swelling on anterosuperior aspect of the shoulder after trauma} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Symptoms start in the traps,shoulder and neck but move to the AC joint} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Painful with bench pressing, dips or laying on the affected side} \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Bruising/defomity on clavicular prominence} \tn 
% Row Count 7 (+ 1)
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\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Diagnostic findings}}  \tn
% Row 0
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\mymulticolumn{2}{x{17.67cm}}{- Swelling, bruising and deformity on clavicular prominence} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Tenderness over AC} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Feeling of giving way on palpation of distal clavicle (+ve Piano Key sign)} \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- ROM painful and limited - abduction most affected} \tn 
% Row Count 7 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- +ve Cross body adduction} \tn 
% Row Count 8 (+ 1)
% Row 5
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\mymulticolumn{2}{x{17.67cm}}{- +ve BvR} \tn 
% Row Count 9 (+ 1)
% Row 6
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\mymulticolumn{2}{x{17.67cm}}{- +ve Paxino} \tn 
% Row Count 10 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- +ve Buchberger test} \tn 
% Row Count 11 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Associated with fractured clavicle, impingement syndromes and neurovascular insults} \tn 
% Row Count 13 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Consider active vs passive ROM - Rotator cuff \newline - Buchberger test distinguishes subacromial impingement from AC joint sprain (more pain in external rotation) \newline - Evaluate entire clavicle and SC for other injuries \newline - Perform full neurovascular exam on affected side}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{DDx}}  \tn
% Row 0
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\mymulticolumn{2}{x{17.67cm}}{- Clavicular f\#} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Rotator Cuff lesion} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Shoulder Anterior impingement syndrome} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Shoulder dislocation} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Labral injury} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Osteolysis of distal clavicle} \tn 
% Row Count 6 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Neoplasm} \tn 
% Row Count 7 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Rheumatologic disease} \tn 
% Row Count 8 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Cervical spine/viscerosomatic referral} \tn 
% Row Count 9 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Shoulder osteoarthritis} \tn 
% Row Count 10 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Adhesive Capsulitis} \tn 
% Row Count 11 (+ 1)
% Row 11
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Erb Duchenne} \tn 
% Row Count 12 (+ 1)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Septic Arthritis} \tn 
% Row Count 13 (+ 1)
% Row 13
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- CRPS} \tn 
% Row Count 14 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Radiographs}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{17.67cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/siffi_1609770655_msk-2-3.jpg}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{AP, lateral, and axillary lateral views \newline - Not often apparent on x-ray - Zanca view (tilting of beam 10-15 degrees caudal and bilateral AP views), weighted stress views \newline - MRI only used to rule out other pathologies of the shoulder \newline - X-ray shows AC joint separation (type 3) due to ligament injury}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Management}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Grade I + II - Protection, immobilisation (sling for 3-10 days), mobility and strengthening} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Passive mobility exercises (avoid exercises that involve behind back internal rotation, crossbody adduction and forward elevation)} \tn 
% Row Count 5 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Strengthening (closed chain scapula stability exercises - scapula clocks} \tn 
% Row Count 7 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Prognosis is favourable \{\{nl\}\} - Usually regains motion by six weeks and regain normal function within 12 weeks} \tn 
% Row Count 10 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Surgery for IV-VI types (six week immobilisation with up to six months recovery time)} \tn 
% Row Count 12 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- AC joint arthritis and joint pain can occur in future} \tn 
% Row Count 14 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Type III-VI should have regular appointments by a orthopaedic surgeon/physician} \tn 
% Row Count 16 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}



\end{document}