Evan Schwartz, M.D.: InjuryDetail: Acromioclavicular (AC) Separation
 
Injuries and Conditions: Shoulder: Acromioclavicular (AC) Separation : Medical Details
 
Overview
An AC separation, or shoulder separation is a partial or complete disruption of the joint capsule surrounding the acromio clavicular joint. The injury may also involve tearing or rupture of the coracoclavicular ligament and/or fracture of the end of the clavicle. The injury is classified or graded in severity with Roman numerals I-VI:

I. The AC joint is partially disrupted
II. The AC joint and the CC (coracoclavicular) ligament partially disrupted
III. The AC joint and the CC are completely disrupted
IV. A grade III injury with avulsion of the CC from the clavicle and associated soft tissue injury.
V. A grade IV injury with posterior dislocation of the clavicle behind the acromion.
VI. A grade V injury with inferior and lateral dislocation of the clavicle.



Causes of Injury
  • A direct blow to the shoulder can force the scapula down. The collarbone is unable to follow the downward motion of the scapula, and the ligaments joining the scapula and the collarbone stretch, tear and separate.
  • Based on the force and type of injury, tears in the trapezious and deltoid muscle attachments may also occur with this injury.



    •
    Diagnosis
    The diagnosis of an AC joint sprain is usually made by observation of symptoms as well as a detailed history and physical exam performed by an orthopaedic surgeon. Diagnostic imaging (X-rays) studies will be obtained to look for fractures or other underlying conditions; the X-rays are also used to document the grade of the sepeartion.

    Grade IV, V and VI injuries are relatively uncommon injuries, accounting for approximately 10 percent of all AC Joint separation injuries. These are the most severe grades of injury, and are typically the result of especially traumatic events, such as an automobile accident or a particularly traumatic fall.

    Symptoms

  • A "bump" may be present over the tip of the collarbone.
  • Symptoms can range from tenderness over the joint to a complete seperation of the AC Joint, with considerable swelling and obvious deformity of the shoulder.
  • Bluish bruising may appear soon after the injury.
  • A popping or tearing sensation inside the injured shoulder may occur with movement.
  • The inability to lift the arm away from the body due to severe pain.

    • Anatomy
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     Product Considerations
    NSAIDs
     NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) are a group of drugs used to control pain. This category of medications includes both prescription and common over-the-counter painkillers such as ibuprofen. NSAIDs are effective for many types of pain that can occur because of inflammation of muscles, joints and bones. The drugs work quickly and people often notice some benefit within a few hours of taking the tablet. However, the complete effectiveness of the drug may not be realized for up to four weeks. For each individual, some varieties of NSAIDs are more effective than others. Often, patients will find that one or two varieties are helpful whereas others may not be as effective in controlling symptoms. It is usually necessary to try several brands and continue with the one that is most suitable. NSAIDs can be used to treat:
  • Pain resulting from inflammation or swelling.
  • Pain after injury.
  • Joint pain and arthritis.


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