acromioclavicular fracture

Traumatology : 

Traumatology Dr. Mina Nasser Wagih Undergraduated 3rd year, Faculty of physical therapy . Cairo Uni.

Acromio-clavicular joint : 

2 Acromio-clavicular joint Definition The acromioclavicular (AC) joint is located between the acromion (a projection of the scapula that forms the point of the shoulder) and the clavicle (the collar bone). This is a gliding type of joint. The ligaments that serve to support and strengthen this joint are called the capsular; superior and inferior acromioclavicular; articular disk; and coracoclavicular (trapezoid and conoid) ligaments.

Acromio-clavicular joint : 

3 Acromio-clavicular joint Anatomy The shoulder is made up of three bones: the scapula (shoulder blade), the humerus (upper arm bone), and the clavicle (collarbone). The part of the scapula that makes up the roof of the shoulder and connects with the clavicle is called the acromion. The joint where the acromion and the clavicle join is the AC joint

Acromio-clavicular joint : 

4 Acromio-clavicular joint Incidence Acromioclavicular (AC) joint injuries most commonly occur in active or athletic young adults. Although uncommon, pediatric AC injuries are increasing because of the rising popularity of dangerous summer and winter sporting activities.

Acromio-clavicular joint : 

5 Acromio-clavicular joint Acromioclavicular dislocation Mechanism of innjury indirect is a common injury, occurring in greater than 10% of shoulder injuries. Most of these injuries occur when the subject falls and strikes the adducted shoulder against the ground against the

Acromio-clavicular joint : 

6 Acromio-clavicular joint Symptoms In its early stages, AC joint osteoarthritis usually causes pain and tenderness in the front of the shoulder around the joint. The pain is often worse when the arm is brought across the chest, since this motion compresses the joint. The pain is vague and may spread to include the shoulder, the front of the chest, and the neck. If the joint has been injured in the past, there may be a bigger bump over the joint on the affected shoulder than on the unaffected shoulder. The joint may also click or snap as it moves.

Acromio-clavicular joint : 

7 Acromio-clavicular joint Classification Allman and Tossy initially proposed a 3-grade classification that Rockwood expanded to 6 types of injury. Grades I and II are the same in both classification schemes with grade III injuries in the Tossy classification subdivided into grades III, IV, V, and VI in the Rockwood classification

Acromio-clavicular joint : 

8 Acromio-clavicular joint The Rockwood classification is as follows: Type I - Minor sprain of AC ligament, intact joint capsule, intact CC ligament, intact deltoid and trapezius Type II - Rupture of AC ligament and joint capsule, sprain of CC ligament but CC interspace intact, minimal detachment of deltoid and trapezius Type III - Rupture of AC ligament, joint capsule, and CC ligament; clavicle elevated (as much as 100% displacement); detachment of deltoid and trapezius Type IV - Rupture of AC ligament, joint capsule, and CC ligament; clavicle displaced posteriorly into the trapezius; detachment of deltoid and trapezius Type V - Rupture of AC ligament, joint capsule, and CC ligament; clavicle elevated (more than 100% displacement); detachment of deltoid and trapezius Type VI (rare) - Rupture of AC ligament, joint capsule, and CC ligament; clavicle displaced behind the tendons of the biceps and coracobrachialis

Acromio-clavicular joint : 

9 Acromio-clavicular joint The pediatric Rockwood classification is as follows: Type I - Clavicle stable; joint radiographically normal Type II - Partial tear of the periosteal tube, allowing for some mobility of the distal clavicle; AC ligament disrupted Types III-VI - Larger tear through the periosteal tube, allowing for greater clavicle mobility and gross instability with clavicle positioning; CC ligament remains attached to the clavicle periosteal tube

Acromio-clavicular joint : 

10 Acromio-clavicular joint Treatment Non-surgical Treatment Initial treatment for AC joint osteoarthritis usually consists of rest and anti-inflammatory medications such as aspirin or ibuprofen. A rehabilitation program may be directed by a physical or occupational therapist. If the pain doesn't go away, an injection of cortisone into the joint may help. Cortisone is a strong medication that decreases inflammation and reduces pain. Cortisone's effects are often temporary, but it can give very effective relief in the short term

Acromio-clavicular joint : 

11 Acromio-clavicular joint Surgery If nonsurgical measures fail to relieve your pain, your doctor may recommend surgery. The most common procedure for AC joint osteoarthritis is resection arthroplasty. A resection arthroplasty involves removing a small portion of the end of the clavicle. This leaves a space between the acromion (the piece of the scapula that meets your shoulder) and the cut end of the clavicle, where the joint used to be. Your surgeon will take care not to remove too much of the end of the clavicle to prevent any damage to the ligaments holding the joint together. Usually only a small portion is removed, less than one cm (about three-eighths of an inch). As your body heals, the joint is replaced by scar tissue. Remember, the AC joint doesn't move much, but it does need to be flexible. The scar tissue allows movement but stops the bone ends from rubbing together.

Acromio-clavicular joint : 

12 Acromio-clavicular joint This procedure can be done in two ways. Today, it is more common to do this procedure using the arthroscope. An arthroscope is a slender tool with a tiny TV camera on the end. It lets the surgeon work in the joint through a very small incision. This may result in less damage to the normal tissues surrounding the joint, leading to faster healing and recovery. The older open method of performing this operation is done by making a small incision, less than two inches long, over the AC joint. The AC joint is very close to the surface of the skin and can be easily reached through a small incision. The surgeon can then use a special saw or other instrument to shave off a small portion of the end of the clavicl

Acromio-clavicular joint : 

13 Acromio-clavicular joint Nonsurgical Rehabilitation If you don't need surgery, range-of-motion exercises should be started as pain eases, followed by a program of strengthening. At first, exercises are done with the arm kept below shoulder level. The program advances to include strength exercises for the rotator cuff and shoulder blade muscles. The goal is to get your shoulder moving smoothly and to learn how to control your symptoms. You will probably progress to a home program within four to six weeks.

Slide 14: 

14 Thank You Dr.Mina Nasser