Acromioclavicular Joint Disorders: Difference between revisions
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<br>In a type III lesion and a severe dislocation, there is sometimes a surgical procedure needed. For example with a screw for the stabilization of clavicle to the processus coracoideus.<ref name="'Phemister'">Phemister DB. The treatment of dislocation of the acromioclavicular joint by open reduction and threaded-wire fixation. J Bone Joint Surg Am 1942;24:166–8.</ref> First a sling or brace will be applied for 2 a 3 week. After removing the brace, a physiotherapeutic treatment can beginning. | <br>In a type III lesion and a severe dislocation, there is sometimes a surgical procedure needed. For example with a screw for the stabilization of clavicle to the processus coracoideus.<ref name="'Phemister'">Phemister DB. The treatment of dislocation of the acromioclavicular joint by open reduction and threaded-wire fixation. J Bone Joint Surg Am 1942;24:166–8.</ref> First a sling or brace will be applied for 2 a 3 week. After removing the brace, a physiotherapeutic treatment can beginning. | ||
== Physical Therapy Management <br> | == Physical Therapy Management <br> == | ||
The distinction between treatment for type I and type II lies in the speed of rehabilitation. The rehabilitation is often longer when you have a type II injury but the rehabilitation is the same for type I. After the application of ice and anti-inflammatory products it is important to start as soon as possible with mobilization and active exercises. Active exercises like moving the fingers, wrist and elbow to prevent stiffness. After that you can begin with more targeted shoulder exercises. When the pain is reduced and mobility promoted you can start strengthening exercises.<br> | |||
== Key Research == | == Key Research == |
Revision as of 21:59, 12 January 2011
Original Editors - Mathilde De Dobbeleer
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Search Strategy[edit | edit source]
Databases searched: Pubmed, Pedro and Web of Knowledge
Keywords searched: Acromioclavicular Joint, Physiotherapy, Treatment, Examination, Dysfunction
Definition/Description[edit | edit source]
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Clinically Relevant Anatomy[edit | edit source]
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Epidemiology /Etiology[edit | edit source]
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Characteristics/Clinical Presentation[edit | edit source]
Acromioclavicular injuries are frequent in contact sports: in American football, rugby and ice hockey but also by alpine skiing, snowboarding and bicycling. [1] [2] AC -joints often occur when falling on the shoulder, collision whit another player or while being tackled. During the fall will the shoulder hit the ground and the scapulae will be pushed down. The clavicle can only partially follow this movement and there will be a great deal of strain on the ligaments causing them to rupture or dislocation due to market.
There may prevent different injuries at the acromioclavicular joint. These are often divided into three groups, this classification is the most common.
o Type I: In a type I is a partial injury to the joint capsule. Paired whit an incomplete tear of the acromioclavicular ligaments and joint capsule.
o Type II: A type II injury is a moderate injury. A partial tear of the ligament coracoclavicular (ligament between coracoideus and clavicle) with a rupture of the capsule and the acromioclavicular ligament. Often described as a subluxation.
o Type III: A type III injury is a severe injury. Complete rupture of the acromioclavicular ligament but also the coracoclavicular ligament. This can lead to displacement of the clavicle and are therefore very unstable.
This is often described as a dislocation.
Type III dislocation problems, which are very complex and therefore further divided into 3.
o Type IV: Dislocation with posterior dislocation of the clavicle.
o Type V: Dislocation whit severe upward displacement of the clavicle into or through the Trapezius.
o Type VI: This is a rare injury. Dislocation of the clavicle inferiorly, locked under the coracoids process.
Rockwood classification [3]
Differential Diagnosis[edit | edit source]
Most common complaints are often pain, numbness and swelling in the AC joint. In type I lesions are swelling and pain the most common, especially in the abduction of the arm.
In type II injuries may be a moderate to severe pain caused and each movement of the arm can pain create. From Type III injuries are in addition to these symptoms are also very pronounced deformations occur. In these types will be clearly felt that the clavicle can move. The displacement of the clavicle can be better seen in adduction of both arms. Also the different shoulder movements will be greatly reduced.
Diagnostic Procedures[edit | edit source]
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Outcome Measures[edit | edit source]
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Examination[edit | edit source]
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Medical Management
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The treatment of injuries of the AC joint will vary depending on the severity or degree of the injury. The first treatment that is best used is ice application within 24 hours to 48 hours and anti-inflammatories. Also used is a atella that is tied to the shoulder, but a high quality atella should be used which unable the patient to use arm holding the arm against the abdomen(add illustration), this will provide a temporary but strict immobilization. For large dislocations (type IV –VI) when the clavicle has shifted is a surgery necessary. [4]
In a type III lesion and a severe dislocation, there is sometimes a surgical procedure needed. For example with a screw for the stabilization of clavicle to the processus coracoideus.[5] First a sling or brace will be applied for 2 a 3 week. After removing the brace, a physiotherapeutic treatment can beginning.
Physical Therapy Management
[edit | edit source]
The distinction between treatment for type I and type II lies in the speed of rehabilitation. The rehabilitation is often longer when you have a type II injury but the rehabilitation is the same for type I. After the application of ice and anti-inflammatory products it is important to start as soon as possible with mobilization and active exercises. Active exercises like moving the fingers, wrist and elbow to prevent stiffness. After that you can begin with more targeted shoulder exercises. When the pain is reduced and mobility promoted you can start strengthening exercises.
Key Research[edit | edit source]
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Resources
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Clinical Bottom Line[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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- ↑ Webb J, Bannister G. Acromioclavicular disruption in first class rugby players. Br J Sport Med. 1992;26:247-248.
- ↑ Kelly BT, Barnes RP, Powelle JW et al. (2004) Shoulder injuries to quarterbacks in the National Football League. Am J Sports Med 32(2):328–331
- ↑ Rockwood CA Jr, Young DC. Disorders of the acromioclavicular joint. In: Rockwood CA Jr, Matsen FA Hi, eds. The Shoulder. Philadelphia, PA: WB Saunders; 1990:413-476.
- ↑ Collins DN. Disorders of the acromioclavicular joint. In: Rockwood CA Jr, Matsen FA III, Wirth MA, Lippitt SB, Fehringer EV, Sperling JW, editors. The shoulder. Vol. 4, 4th ed. Philadelphia: Saunders Elsevier; 2009. p. 453-526.
- ↑ Phemister DB. The treatment of dislocation of the acromioclavicular joint by open reduction and threaded-wire fixation. J Bone Joint Surg Am 1942;24:166–8.