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Case of the Month - July 2020

AC Joint Separation Treated with Reconstructive Surgery

Four months after Left shoulder acromioclavicular joint and coracoclavicular ligament reconstruction (ACCR). Full range of motion, full strength and no pain.

Case: 27 year old male engineer who had a hard fall onto his dominant left shoulder while skiing sustaining a high grade (Type V) acromioclavicular (AC) joint separation. I trial of rest, icing, anti-inflammatories and exercises did not resolve his pain and loss of function. Given his functional goals and active lifestyle, surgery was recommended. The patient elected to undergo surgery and had a successful recovery regaining full range of motion, strength and no pain.

Pre-operative XR showing a Type V AC joint separation involving complete tearing of the AC and CC ligaments.

Post-operative XR following reconstructive surgery of the AC joint and CC ligaments.

AC Joint Injury Overview

Shoulder injuries of the acromioclavicular (AC) joint are common. An AC joint injury can result from a hard fall, accident, or from a traumatic event. An AC joint injury can result in a severe AC sprain, AC fracture or an AC joint separation, which occurs when the collarbone (clavicle) separates from the shoulder blade (acromion). An AC joint injury is measured in varying grades. For example, a Type I injury will bring mild shoulder pain because the AC ligaments are simply stretched. A higher grade injury can include a partial shoulder CC (coracoclavicular) ligament tear, a full shoulder CC ligament tear resulting in AC separation. Dr. Ziegler has experience in successfully treating acromioclavicular joint pain and AC joint injuries.

Symptoms of an AC Joint Injury

Symptoms of an injured AC joint will range from mild tenderness to intense, sharp shoulder pain that is typically caused by a complete shoulder separation. In a higher grade shoulder injury, a popping sensation will often be heard and prominent shoulder bruising will take place on the skin. A significant prominence over the top of the shoulder is also present in higher grade injuries. Each varying grade of acromioclavicular joint injury can requires a different treatment option. The first step to determining the exact injury grade is a proper diagnosis and examination by Dr. Ziegler.

Treatment Options for an AC Joint Injury

Treatment for a lower grade acromioclavicular joint injury will usually consist of rest, anti-inflammatories, use of a shoulder sling and physical therapy. More advanced AC joint injuries can cause shoulder instability, weakness, early fatigue and persistent pain with activity. Advanced AC joint injuries can cause lost time at work, decreased activities, decreased function and, if left untreated, can lead to early arthritis or permanent damage to the shoulder joint. In these individuals, more care is needed and surgery may be required.

AC Joint Surgery

Repair/Reconstruction of the AC joint is recommended for patients with continued symptoms in the setting of higher grade injury that has failed conservative treatment. The goal is to secure the injured AC joint back into the proper position. This specialized surgery can be performed on an outpatient-basis and full range of motion is typically re-established quickly. The results of the surgery are most effective when a post-operative rehabilitation program involving physical therapy and shoulder exercises are implemented and followed closely.

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