AC Joint Injuries and Surgery
Overview
The acromioclavicular (AC) joint is a joint located at the top of the shoulder, where the collarbone (clavicle) meets the shoulder blade (scapula, acromial process). The AC joint is important for shoulder movement and stability, and is frequently injured in sports and other activities that involve falls or impacts directly to the shoulder. The coracoclavicular (CC) ligaments are a pair of ligaments that connect the coracoid process (a bony projection on the shoulder blade) to the collarbone. The CC ligaments are an important part of the shoulder's supporting structure, helping to maintain the position of the collarbone and provide stability to the AC joint.
Types of AC Joint Injuries
There are several different types of AC joint injuries, ranging from mild sprains to more severe dislocations. Some common types of AC joint injuries include:
- AC joint sprains: These are relatively mild injuries that occur when the ligaments surrounding the AC joint are stretched or torn. Symptoms may include pain, swelling, and tenderness around the AC joint.
- AC joint separations: These injuries involve a partial or complete separation of the AC joint. They are typically more severe than AC joint sprains and can cause more significant pain and disability.
- AC joint dislocations: This is the most severe type of AC joint injury, and occurs when the collarbone becomes completely separated from the shoulder blade. AC joint dislocations are usually accompanied by significant pain and disability.
Symptoms
The symptoms of AC joint injuries can vary depending on the severity of the injury. Some common symptoms include:
- Pain: This is the most common symptom of AC joint injuries, and may be felt at the top of the shoulder or along the collarbone.
- Swelling: Swelling around the AC joint may occur after an injury, and can make the shoulder look and feel larger than normal.
- Tenderness: The AC joint may be tender to the touch after an injury, especially when pressure is applied to the area.
- Deformity: You may notice that the contour of the shoulder is not normal, with a large ‘bump’.
- Limited range of motion: AC joint injuries can limit the range of motion in the shoulder, making it difficult to move the arm in certain directions.
Diagnosis
A thorough physical examination will assess your strength, range of motion, and certain provocative tests can help narrow down the source of your symptoms. X Rays will evaluate for any fractures, bone loss, or arthritis. An MRI is typically also necessary to evaluate for soft tissue tears and/or inflammation within the shoulder.
Prevention
There are several things that can be done to help prevent AC joint injuries:
- Wear protective equipment: Wearing appropriate protective equipment, such as shoulder pads, can help reduce the risk of AC joint injuries in sports and other activities.
- Strengthen shoulder muscles: Strong shoulder muscles can help provide stability and support to the AC joint, reducing the risk of injury.
- Use proper technique: Using proper technique, such as proper form when lifting, falling, or tackling, can help reduce the risk of AC joint injuries.
- Avoid overexertion: Pushing the body beyond its limits can increase the risk of AC joint injuries. It is important to listen to the body and take breaks as needed to prevent overexertion.
Initial Treatments
The treatment of AC joint injuries will depend on the severity of the injury and the individual's symptoms. Some common treatments for AC joint injuries include:
- Rest and ice: Resting the shoulder and applying ice to the area can help reduce pain and swelling.
- Medications: Over-the-counter pain medications, such as acetaminophen or ibuprofen, can help manage pain.
- Physical therapy: A physical therapist can help the individual regain strength and range of motion in the shoulder through a variety of exercises and stretches.
- After a brief period of rest and immobilization lasting no longer than a week, I recommend beginning to gently stretch the shoulder and regain range of motion.
Injections
Injections, including cortisone and PRP (platelet rich plasma), can also be utilized to lessen the pain from an AC joint injury.
Imaging for AC Joint Injuries
Imaging tests can be helpful in diagnosing AC joint injuries and determining the appropriate treatment. Some common imaging tests for AC joint injuries include:
· X-ray: X-rays can be used to visualize the bones of the shoulder, including the collarbone and shoulder blade. They can help diagnose fractures or dislocations of the AC joint.
· MRI: Magnetic resonance imaging (MRI) uses radio waves and a strong magnetic field to produce detailed images of the soft tissues, including ligaments and tendons. MRI can be helpful in diagnosing more subtle AC joint injuries, such as sprains or partial separations.
· CT scan: Computed tomography (CT) scans use X-rays and computer technology to create detailed images of the body. CT scans can be helpful in evaluating the bones and surrounding structures in the shoulder, including the AC joint.
Surgery for AC Joint Injuries
Surgical treatment for AC joint separations is usually reserved for more severe injuries, such as those that involve complete tears of the ligaments or significant instability in the shoulder. Some common criteria for surgical treatment of AC joint separations include:
- Persistent pain or instability: If the individual is experiencing ongoing pain or instability in the shoulder despite conservative treatment, surgery may be recommended.
- Inability to return to normal activities: If the individual is unable to return to their normal activities, such as work or sports, due to pain or instability in the shoulder, surgery may be considered.
- Failure of conservative treatment: If conservative treatment methods, such as rest, ice, physical therapy, and medications, have not been effective in improving symptoms, surgery may be recommended.
- Severe ligament damage: If the ligaments supporting the AC joint are severely damaged or completely torn, surgery may be necessary to repair or reconstruct the ligaments.
It is important to discuss all surgical options with a surgeon and weigh the potential risks and benefits before deciding on a course of treatment.
AC Joint Surgery in Oregon
Dr. Daniel Elkin is a leading Orthopedic Surgeon performing Shoulder and Elbow Surgery in the Willamette Valley. He specializes in complex shoulder and elbow repairs and shoulder arthroscopy and is conveniently located in Salem, Oregon