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AC Joint Separation

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  • 1.  A 42yo presents to the ED after being struck in the right shoulder with a baseball bat. On exam, he refuses to move his shoulder secondary to pain and is tender on the top of his shoulder.
  • 2.  Classic imaging appearance  Widening of the acromioclavidular (AC) joint space ≥3mm with or without widening of the coracoclavicular (CC) distance
  • 3.  Type I  Mild, bruised ligaments, no actual separation of the AC joint—a clinical diagnosis  Type II  Moderate, partial tear in the AC ligaments, ≥ 3mm separation of the AC joint  Type III  Severe, complete tear of the AC as well as the CC ligaments, compete separation of the AC joint  Type IV  Type III injury and associated posterior dislocation of the distal end of the clavicle
  • 4.  Type I  Sling and adhesive strapping  Excellent prognosis  Type II  Same as above +/- arthroplasty  90% recover; 10% require surgery  Type III  Internal fixation; fixation screw being passed from the clavicle downwards into the coracoid process  80% good; 20% require reoperation  Type IV  Open reduction and internal fixation  Similar to type III
  • 5.  History typically of a direct blow to tip of shoulder, downward blow to the clavicle (sports), applying traction to the arm, or falling on the hand or elbow with the arm flexed at 90 degrees  Comparison with the contralateral side should be made before establishing the diagnosis, due to the large amount of anatomical variance  Associated with fractures of coracoid process and distal end of the clavicle
  • 6.  Marx J MD; Hockberger R MD; Walls R MD. Rosen’s emergency medicine. 7th ed.  Simon R; Sherman S; Koenigsknecht S. Emergency orthopedics: the extremities. 5th ed. McGraw Hill Publishing.  Wheeless C R III MD. Wheeless textbook of orthopedics. www.wheelessonline.com.