• Clinical science

Acromioclavicular joint injury

Summary

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.

Etiology

  • 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

Clinical features

References:[1]

Diagnostics

Rockwood classification of AC joint injury
Injury type AC ligament Joint capsule CC ligament Distal clavicle Deltoid and trapezius muscles
Type I
  • Sprained
  • Intact
  • Intact
  • Intact
  • Intact
Type II
  • Ruptured
  • Sprained
  • AC joint widening and minimal elevation
  • Possibly partial detachment from clavicle
Type III
  • Ruptured
  • Moderately elevated and unstable to stress
  • Reducible (“piano key” sign)
Type IV
  • Ruptured
  • Posteriorly displaced through the trapezius
  • Not reducible
Type V
  • Ruptured
  • Severely elevated
  • Not reducible
Type VI (rare)
  • Ruptured
  • Inferiorly displaced in subcoracoid position

References:[2][3][4][5]

Treatment

Conservative treatment

Surgical treatment

  • Indications:
    • 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
  • Objective: ligament repair and reconstruction
  • Methods
    • Athroscopic (all or assisted): preferred as less invasive
    • Open surgery

References: [1][2]

Complications

We list the most important complications. The selection is not exhaustive.