Please enable JavaScript.
Coggle requires JavaScript to display documents.
AC/SC injuries - Coggle Diagram
AC/SC injuries
classification
Type 1: Sprain of AC lig, AC/CC ligs intact
-mild/mod pain at AC
-general movement in pain free
-TTP
-no instability/minimal lig damage
-radiographs are normal
-
Type 2: complete disruption of AC, sprain of CC ligs
-mod/severe pain at both AC and CC interspace, limited function
-definite horizontal instability
-possible slight change in vertical stability
-slight elevation of clavicle on radiographs
Treatment:
-sling as needed
-ice for pain
-ROM initiated as tolerated, often as passive to limit deltoid/UT contraction
-functional progression, donut pad, deltoid/UT should be considered in long term as they reinforce AC
-return to sport in 2-3 weeks
Type 3: complete disruption of AC/CC
-high-riding clavicle, exquisite pain, inability to use UE
-involved arm often cradled
-AC/horizontal and CC/vertical instability
-25-100% inc in CC space
Operative Management:
-pull o r stabilize clavicle to coracoid
-complications: infection, pin breakage, wire/pin migration and resection of clavicle/coracoid
-residual deformity or discomfort may occur
-4-6 weeks immobilization
functional outcomes similar to nonoperative management
Nonop management:
-similar to type 2 management, but greater reliance on immobilizing support device s/t vertical instability
-residual step down deformity-rarely becomes disability
-similar to outcomes with surgery
-disability most likely a problem in patients who regularly expose arm to high demands so surgeon may opt to perform surgery
Type 4-6: severe pain and limited function, extreme drooping of involved UE
-horizontal/vertical instability, surgical intervention directed at restoration of ligamentous complexes and musc insertions
-severe displacement of CC follows: type 4-sup/pos displacement of clavicle, type 5-100-300% inc in CC space, type 6-clavicle displaced inf to coracoid
-Treatment:
-reduction and maintenance for comfort is the rule
-may be corrected surgically, should follow up with physician
-true reduction is not maintained
-arm is immobilized in sling
-kenny-howard harness is most common device (?)
-outcomes of treatment with harness or benign neglect are similar
-pt compliance can be a problem with devices
AC joint
-diarthrodial plane joint
-fibrocartilage surface
-convex clavicle on concave clavicle
-meniscus like disc located bw joint surfaces which begins to degenerate bw 3/4th decade of life
-clavicle rotates early and late during shoulder abduction and elevation
ligaments: AC joint, conoid and trapezoid
-sup/inf AC ligs reinforce joint capsule-control horizontal movements of clavicle
-vertical stability controlled by CC ligs-coind lies medial to joint and runs post. trapezoid positioned laterally and in sagittal plane
-CC ligs are critical to controlling clavicle rotation enabling full elevation
-
-
typical MOIs for AC
-direct force to tip of the shoulder with arm adducted-acromion is driven downward/inferior with resultant ligament disruption
-AC and CC ligaments at risk of injury
-location and # of ligaments affected directly related to level of force
-secondary mechanism is FOOSH-impact load occurs through acromion. Typically only involves AC capsule and ligaments
-
-
-
-
-
-
-