2. 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.
3.
4. Classic imaging appearance
Widening of the acromioclavidular (AC) joint space
≥3mm with or without widening of the coracoclavicular
(CC) distance
5. 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
6. 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
7. 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
8.
9. 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.