The Acromioclavicular Separation: What do I need to know?

28 Jun

There are 6 types of AC separations that are treated differently:

Type I: AC ligament sprain w/ joint intact.  Treated w/ ice, rest, protection w/ sling.

Type II: AC ligament torn, coracoclavicular ligament intact, AC joint subluxed.  Treated with ice, analgesia, 3-7 days of immobilization in a sling.

Type III: AC and CC ligaments torn, complete dislocation of the jointMostly non-op.  Rest, ice, immobilization for 2-3 weeks.  Return to normal activity in 6-12 weeks.

Type IV: Complete dislocation w/ posterior displacement of the distal clavicle into or through the trapezius.  Needs reduction-open or closed followed by conservative treatment similar to Type III.

Type V: Superior dislocation of the jointof 1-3 times normal spacing, disruption of the deltotrapezius fascia.  Requires open reduction, reconstruction of the CC ligament, and repair of the deltotrapezial fascia.

Type VI: Complete dislocation w/ inferior displacement of the distal clavicle into a subacromial or subcoracoidposition.  Requires open reduction and can sometimes damage neurovascular bundle beneath.

Submitted by W. Brooks.

Reference(s): UpToDate, Decision making: operative versus nonoperative treatment of acromioclavicular joint injuries, Bradley JP, Elkousy H, Clin Sports Med. 2003;22(2):277.; picture

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