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AC Joint Separation

Acromio-Clavicular (AC) joint injury, also known as "AC joint separation", is a common condition suffered by 20-30 year old males playing contact sports.

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    Overview

    What is AC Joint Injury?

    Acromio-Clavicular (AC) joint injury, also known as “AC joint separation”, is a common condition suffered by 20-30 year old males playing contact sports whereby traumatic impact to the point of the shoulder causes injury to the ligaments that hold the collar bone down against the point of the shoulder resulting in the collar bone separating from the shoulder. Not to be confused with shoulder dislocation injury, AC joint separation is a unique condition with completely different signs and symptoms, requiring different types of treatment. There are 6 grades of AC joint separation injury according to the severity of the injury sustained. Grade 1 AC joint separation Mild sprain of the AC ligament with no collar bone elevation. Grade 2 AC joint separation Complete rupture of the AC ligament, AC joint capsule, sprained Coraco-Claviclular (CC) ligament and mild collar bone elevation. Grade 3 AC joint separation Complete rupture of the AC ligament, AC joint capsule and CC ligament with detached deltoid and trapezius muscles and mild elevation of the collar bone above the level of the acromion or point of the shoulder. Grade 4 AC joint separation Complete rupture of the AC ligament, AC joint capsule and CC ligament with detached deltoid and trapezius muscles and mild elevation of the collar bone and posterior displacement of the clavicle. Grade 5 AC joint separation Complete rupture of the AC ligament, AC joint capsule and CC ligament with detached deltoid and trapezius muscles and marked elevation of the clavicle above and toward the back of the level of the acromion, or point of the shoulder. Grade 6 AC joint separation Complete rupture of the AC ligament, AC joint capsule and CC ligament with detached deltoid and trapezius muscles and marked depression of the clavicle down toward the coracoid process of the shoulder blade. Acute AC joint injury? You need a shoulder expert! If you’ve just hurt your shoulder playing contact sport, you need an expert diagnosis right away. AC joint separations are very painful injuries. Dr Gupta uses a systematic approach to diagnosis, treatment and return to sport or work advice is necessary to take back control of your condition and to prevent future complications or re-injury. Contact Dr Gupta on 02 9687 8344 or make an online booking here.

    Symptoms & Causes

    Symptoms

    AC joint injury may exhibit the following symptoms;

    • Very painful
    • Clicking, cracking and unusual sounds with shoulder movement
    • Loss of some shoulder movement, in particular reaching up and across the body
    • Disfigurement of the shoulder with an abnormal bony bump at the top of the shoulder
    • Strong muscle contraction and spasm of the shoulder
    • Associated swelling and bruising of the shoulder

    Causes
    The AC joint is found at the very top of the shoulder where the collar bone meets the acromion of the shoulder. Similar to breaking a collarbone, AC joint injury is caused by a fall injury or a direct impact injury.

    Fall Injury
    Falls can be sustained while you are moving or stationary and from a low height or from a greater height. Falls onto the top of the shoulder or falling onto an outstretched arm risk AC joint damage.

    Direct Impact Injury
    Contact sports like AFL, rugby and NRL where fast moving players are stopped suddenly by impact to the point of the shoulder, or when they are tackled and have their shoulder driven into the ground, players risk AC joint injury. The more the impact is from the top of the shoulder, the more likely the injury.

    Diagnosis

    Diagnosis

    To diagnose a broken collar bone, the orthopaedic consultant will check the patient’s;

    • Nature of the injury (sports, work, accident, overuse etc)
    • Cause of the injury (impact, collision, fall, repetitive/slow onset)
    • Context of the suffering (age, return to sport, work, impact on daily living)
    • Perform a physical examination to ascertain pain and range of movement
    • Perform specialised diagnostic tests to confirm diagnosis

    Acute AC Joint Separation

    Acute means sudden and injury occurs immediately. Injuries of this kind can be tested by pressing down on the AC joint to verify movement at the joint indicating it has separated and by X-Ray.

    X-Ray imaging should show the AC joint with the patient standing without holding a weight and then again with holding a weight. Separation comparisons between the two images will suggest the grade or severity of injury.

    Chronic AC Joint Pain

    Chronic means prolonged pain when injury occurs frequently over a period of more than 6 months.

    AC joint separation injuries can become chronic shoulder conditions if they are not treated correctly. These injuries can reoccur with regular frequency where ongoing pain, swelling and inflammation of the condition may occur.

    Treatment

    Treatment

    AC joint separation is a very painful condition that needs to be managed carefully. Treatment begins with a thorough diagnosis to understand the severity of the condition in the context of your age, your sport, your work and your life to understand what is important to you about your recovery. Non-Surgical An AC joint separation injury is typically not indicated for surgery. The non-surgical treatment of the injury requires;

    • Rest and immobilisation by strapping the AC joint down and using a collar and cuff sling
    • Pain and anti-inflammatory medication
    • Consideration for surgery
    • Physiotherapy rehab protocol

    Surgical In severe AC joint separations cases where the patient wishes to return to high demand overhead activities, there may be some consideration for surgery. AC Joint Stabilisation: Where surgery aims to reduce collar bone separation from the shoulder. Post Op Rehab Protocol Dr Gupta uses a clinically proven rehabilitation process for each of his operative procedures. Find out more about AC joint rehabilitation on our AC Joint Stabilisation Protocol Page. If you’ve just hurt your shoulder playing contact sport, you need an expert diagnosis right away. AC joint separations are very painful injuries. Dr Gupta uses a systematic approach to diagnosis, treatment and return to sport or work advice is necessary to take back control of your condition and to prevent future complications or re-injury. Contact Dr Gupta on 02 9687 8344 or make an online booking here.

    Dr Manish Gupta | MBBS FRACS FAOrthoA

    Dr Manish Gupta | MBBS FRACS FAOrthoA

    Dr Manish Gupta is a renowned expert surgeon in the field of Orthopaedic Surgery specialising in Upper Limb including Shoulder, Elbow and Wrist.


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      reception@mgorthopaedics.com.au

      Monday to Friday: 8:30am to 4:30pm

      One Point Health, 510-536 High Street, Penrith, NSW, 2750

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      (02) 9687 8344

      Bella Vista, Hospital for Specialist Surgery, Level 1,Suite 1, 17-19 Solent Circuit, Bella Vista, NSW, 2153

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      (02) 9687 8344

      Suite E Level 3, 20-22 Mons Road Westmead NSW 2154

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