The document discusses AC joint injuries, providing information on mechanisms of injury, grading classifications from I-VI, typical management approaches depending on grade, and two case studies. It notes that AC joint injuries often result from falls on an outstretched hand and outlines the grading system based on ligament disruption and clavicle displacement. While grades I-II are often treated non-operatively and grade III may try non-operative treatment initially, grades IV-VI typically require operative management.

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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