ACROMIOCLAVICULAR

INJURY

Herry S. Natawijaya
Orthopaedic and Traumatology
Bandung

Anatomy
Diarthrodial

joint
Articular surface: hyaline
cartilage fibrocartilage
AC ligament and deltoidtrapezius muscle
horizontal stability
CC ligament : conoid and
trapezoid vertical
stability

Incidence
Rowe

- Marble (1962): 52 AC joint injury

among 1603 shoulder-girdle injury
Thorndike - Quigley (1956): 223 of 578
athletes
Rockwood : 300 of 520 third decades
Male : female = 5:1 to 10 : 1

Classification
Graded by the amount of injury to the AC
and CC ligament
Cadenat (1917), complete and incomplete
Allman-tossy, recognized 3 type
Rockwood dan Salvatore, mencadi 6

Classification

Diagnosis
Mechanism of Injury
Physical Examination
Radiographic findings

Mechanism of Injury
DIRECT FORCE
Falling onto the point
of the shoulder
The arm in an
adducted position

Mechanism of Injury
INDIRECT FORCE
Fall on the
outstretched hand
A force transmitted to
the arm, humeral head,
acromion process
AC injury

Physical Examination
Type

I : minimal pain with arm

movement, no tenderness over CC
interspaces
Type II : subluxation of the AC joint,
moderate to severe pain, clavicle may
superior to the acromion, AC joint pain
when shoulder move, clavicle unstable

Physical Examination
Type III
complete dislocation
of AC joint
upper extremity
adducted
clavicle prominent to
tent the skin
any motion of the arm
increases the pain

Physical Examination
Type IV
same to type II
clavicle displaced
posteriorly
motion of the shoulder
is more painful

Physical Examination
Type V
same with type III
clavicle grossly
superior displaced
toward the base of the
neck
extensive muscle and
soft-tissue disruption

Physical Examination
Type VI
superior aspect of the shoulder flat
acromion is prominent
inferior stepdown of coracoid process
there may be associated fracture of
clavicula and rib

Radiographic findings
AP view
Zanka

view
Axillary lateral view
Stryker notch view
AP Stress view
Lateral Stress view

Radiographic findings

Stryker Notch view

Zanka view

Radiographic findings
AP stress view

Radiographic findings
Type I
Normal
Mild soft-tissue swelling
No widening, no separation, no deformity
Type II
Lateral clavicle slightly elevated
AC joint widened

Radiographic findings
Type III
Complete AC
dislocation
Clavicle displaced
Increase CC interspace

Radiographic findings
Type IV
Posterior displacement
of the distal clavicle
Increase CC interspace

Radiographic findings
Type V
Marked increase CC
interspace
Clavicle grossly
displaced superiorly
from acromion

Radiographic findings
Type VI
Two types of inferior AC
diclocation: subacromial and
subcoracoid
Subacromial type: decrease CC
distance, clavicle is in a
subacromial
Subcoracoid type: reversed CC
distance, clavicle displaced
inferior to the coracoid process

Treatment
Type I
Symptoms subside after 7 10 days
Ice bag
Shoulder protected until painless

Treatment
Type II
Arm sling : 10 -14 days
Early and gradual rehabilitation
Avoid heavy lifting and contact sport : 8 -12
(6) weeks
Persistent pain operative

Treatment
Type III
Controversial non-operative is majority
Non-operative: short-term (1-2 weeks) sling
support, NSAID, early mobilization
Operative:
Possible indication: polytrauma
Various operative procedure

Treatment

Treatment
Type IV and V
Reduction of the deformity and stabilization
of the clavicle
ORIF followed conservative treatment
Repair of the deltotrapezial fascia

Treatment
Type VI
Open reduction by lateral retraction of the
scapula
Clavicle stabilizing:
Deltoid and trapezius muscle repair
AC joint capsule repair

Prognosis
Type

I, excellent
Type II, recover fully, but small percentage
required debridement or excision of clavicle
because of arthritis
Type III,IV,V,VI, excellent result with both
operative and non-operative

Complication
Operative
Wound infection, osteomyelitis, AC
arthritis, soft-tissue ossification, erosions of
bone by metal, late fracture through the
implant holes in the bone, procedure to
remove, migrations of metal, metal failure,
unsightly scar, inadequate purchase of the
fixation, recurrent deformity.

Complication
Non-operative
Tissue interposed, joint stiffness, close
supervision, immobilization device
restrictive and uncomfortable, skin
irritation, lose the reduction, everyday
activities restricted, pressure sores,
deformity, soft-tissue ossification, AC
arthritis.

thank you