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AC Joint injury,shoulder separation , treatment - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes the AC joint injuries and Classifications, how to diagnose it, and the treatment options in a simple and easy way. The AC joint is stabilized by a joint capsule and ligaments. The AC ligament controls the AP translation (horizontal stability). The Cc ligament controls the vertical stability. Two separate coracoclavicular ligaments that stabilize the distal clavicle. These ligaments are the primary stabilizers to superior or vertical migration of the distal clavicle. The conoid is medial (inserts about 4.5 cm from the end of the clavicle). These injuries are classified according to the degree of the injury, the amount and the direction of displacement into six types. Type I: Sprain – pain at the point of the shoulder. Type II: AC ligament ruptures and there is partial displacement of the AC joint (CC ligament is intact). Type III: The AC and CC ligaments are ruptured with superior displacement of the clavicle up to 100% of the clavicle width. There is an increase in the CC ligament distance and the deformity is reducible. Type IV: The ligaments are ruptured and the AC joint is dislocated and displaced posterior through the trapezius muscle. Axillary view x-rays will show this posterior displacement very well. In the axillary view, the anterior aspect of the clavicle and the acromion should align. Type V: greater than 100% displacement of the clavicle superiorly. Marked increase in the CC distance and the deformity is not reducible. There will be marked gross disparity between both the injured and normal shoulder. Type VI: inferior displacement of the clavicle. This type is rare. The distal clavicle lies under the acromion and the coracoid. Injuries to the AC joint are sometimes apparent due to the pain and deformity. Injury results from direct trauma such as a direct fall on the point of the shoulder and if the distal clavicle is prominent, then the patient probably has a high grade injury. If you can reduce the deformity with manual pressure, this probably means that the clavicle did not button hole through the trapezius or deltoid muscles and this determines if the patient will need surgery or not. Be sure to examine the patient carefully because the neurovascular status may be affected, especially if it is a violent trauma that may cause a brachial plexus injury or scapulothoracic dissociation. The amount of displacement can often be difficult to assess on plain x-rays. If the deformity is more than 2 cm, then you probably need to do surgery. The idea is that there is a higher risk of complications with surgical treatment. The result of conservative treatment is usually better with a quick recovery and return to work. With Types I, II and Type III the trend is to do conservative treatment. Conservative treatment in Type III injuries is controversial, especially in athletes. Surgery is better with Type IV, V and Type VI injuries. Nonoperative Treatment •Treatment the patient with a sling for about 7 days followed by range of motion exercises •Patient may develop painful arthritis of the AC joint •Patient may have residual prominence of the distal clavicle and pain with nonoperative treatment that may last for about 6 months. You will work on and stabilize the CC interval •Healing of the ligament will occur with no need for graft augmentation (do CC interval fixation). •Use suture anchors, buttons placed in the coracoid, or sutures passed around the coracoid (both probably have the same result). •May do distal clavicle excision and you also add AC joint fixation with a Hook plate to support the CC ligament repair. •CC ligament fixation in isolation could translate the clavicle anteriorly due to the lack of an anterior AC ligament. Chronic Symptomatic Dislocation Treatment •Do tendon reconstruction if greater than 4 weeks (augmented Weaver-Dunn procedure) •Weaver-Dunn procedure is a good operation when it is performed acutely. •It may not be good alone in chronic injuries •It does not matter which procedure is done, loss of reduction can occur and it usually does not affect the result of the treatment. Become a friend on facebook:   / drebraheim   Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC Donate to the University of Toledo Foundation Department of Orthopaedic Surgery Endowed Chair Fund: https://www.utfoundation.org/foundati...