- Clinical science
Acromioclavicular joint injury is usually caused by direct injury to the acromion during a fall on an adducted arm. It is classified according to the Rockwood classification, which considers the extent of injury to the acromioclavicular (AC) ligament and the coracoclavicular (CC) ligament, as well as the displacement of the clavicle and type of dislocation in the AC joint. Patients present with local tenderness, swelling, limited range of motion, and/or deformity of the joint. X-ray is used to diagnose joint subluxation and clavicular displacement. Treatment is usually conservative and may include rest and analgesia for a few weeks. Surgery is recommended for more severe injuries when ligament repair is required.
- Most common: direct force injury to the superior aspect of the acromion while the arm is adducted (e.g., a fall while cycling or riding a horse)
- Less common: indirect injury via falling on an outstretched hand, which transmits force up the arm though the humerus to the acromion, causing displacement that distresses the AC ligaments
- Approach: AC joint injury is a clinical diagnosis that can be classified according to the Rockwood classification via x-ray. If x-ray findings are questionable, an MRI, CT, or possibly ultrasound may be considered.
|Rockwood classification of AC joint injury|
|Injury type||AC ligament||Joint capsule||CC ligament||Distal clavicle||Deltoid and trapezius muscles|
|Type I|| || || || || |
|Type II|| || || || |
|Type III|| || |
|Type IV|| || |
|Type V|| || |
|Type VI (rare)|| || || |
- X-ray (anterior-posterior view, oblique view, axillary view) of the shoulder joint, acromion, and scapula:
- Indications: types I–II
Types III and above
- Management of type III is controversial and determined on an individual basis. All patients with type III and above should be referred to an orthopedist.
- Open fractures
- Neurovascular injury
- Failed conservative treatment
- Types III and above
- Objective: ligament repair and reconstruction
- Athroscopic (all or assisted): preferred as less invasive
- Open surgery