Acj injuries

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AC Joint Injuries
Puneet Monga
Consultant Orthopaedic Shoulder Surgeon

2. Mechanisms
Fall on outstretched
hand

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Image courtesy: Shoulderdoc

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AC Ligament disruption
1

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AC Ligament disruption
CC Ligament Sprain
II

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III
AC Ligament Disruption
CC Ligament disruption
CC distance 25 to 100 % of
opposite side

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IV
CC Ligament disrupted
Clavicle displaced
posteriorly into trapezius
Deltoid / trapezius disrupted

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V
CC distance 100 to 300%
of opposite side

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VI
Clavicle in subcoracoid position

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Management
Guidance
Grade I - II; Non operative
Grade III; Trial of non operative
Grade IV to VI: Operative
BUT this not always True!!

11. Case 1
22
Male
“Bad Fall”
Grade ?

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Case 1
• Management ?
• Return to Play?

13. Case 2
26 year
male
Office workere- Very fit and active
Fall off bike
Grade of injury ?

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Adducted arm view

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Case 2
• Management ?
• Return to Riding ?

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Case 2

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Post op Rehab
Sling 3-6 weeks
Patient specific rehab

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Challenges
• Early decision making- adjusting the threshold for
surgery
• Managing expectations- Dialing it right for cosmesis!
• Post op compliance