1. ACROMIOCLAVICULAR JOINT INJURIES - SHOULDER SEPARATION BY ISLAY DUFF, MEGHAN MAGNUSSON AND BECCA GRAZIANO

2. The acromioclavicular joint • Location: • Top of the shoulder • Composed of: • 2 bones: Acromion and Clavicle • 2 ligaments: Acromioclavicular and Coracoclavicular (seperated into conoid and the trapezoid sectors) • - Ligaments provide stability for the joint; tearing of the ligament can lead to acromioclavicular sprains and seperations

3. How does this injury Occur? • Sharp blows to the top of the shoulder • Examples: • Sports-related accidents (Mostly high contact sports ie. Football and rugby) • Falling (ie. off a bike or horse) • Car accident

4. SYMPTOMS OF shoulder separation • Symptoms depend of the severity of the injury • (classified by grades) • Grade 1: Tenderness over joint and even throughout entire shoulder • Grade 2: Grade 1 symptoms, swelling and Bruising around shoulder area • Grade 3: Grade 1 & 2 symptoms, popping sensation, bump on shoulder, pain while moving shoulder (especially when raising arm above shoulder)

5. Classifications of the joint injury • BROKEN DOWN INTO 3 GRADE & 6 TYPES (based on severity) • Grade One: TENDER BUT NOT SEPERATED • Type I (Grade 1): • - Injury to the capsule that surrounds the AC join • - Bones are still in position • - Primary symptom is pain

6. CLASSIFICATION OF THE JOINT INJURY • Grade Two: SLIGHT SEPERATION OF THE CLAVICLE FROM THE SHOULDER • Type II (Grade 2): • AC (Acromioclavicular) joint capsule and ligament are partially torn • Patients may have small bump over the AC joint • Type III (Grade 2): • Same type of injury as type II shoulder separation, yet more significant • Patients have large bump over the AC joint

7. Classifications of the joint injury • Grade Three: FULL SEPARATION OF SHOULDER • Type IV (Grade 3): • - unusual injury where the clavicle is pushed behind the AC joint • Type V (Grade 3): • - exaggerated type III injury • - the muscle above the AC joint is punctured by the end of the clavicle causing a significant bump over the injury • Type VI (Grade 3): • also exceedingly rare • the clavicle is pushed downwards, and becomes lodged below the coracoid (part of the scapula)

9. Quick little video... • http://www.youtube.com/watch?v=OfcSvG-dgbY

10. Treatments • Nonsurgical: • -  Immobilize the arm using a sling or brace • Cold therapy • A sports injury specialist or doctor may tape the joint into correct healing position • Anti-Inflammatory medicine to reduce swelling and pain • After some healing physiotherapy is recommended to further healing 

11. Treatments • Surgical:  • -  reconstruction of ligaments • trimming the end of the collarbone to prevent contact with the acromion (Mumford Procedure) • plates and pins may be inserted to improve stability • major seperations often require the Weaver-Dunn Procedure (A 2-inch incision is made over the joint, the end of the clavicle is removed, ligaments are transferred from the underside of the acromion into the cut end of the clavicle to replace torn ligaments)

12. Rehabilitation • Avoid sports until injury has healed • Continue to move shoulder to prevent “frozen” or stiff shoulders • With doctor’s permission; work with trainer or physical therapist to strengthen shoulder (to do shoulder exercises)

13. Post-Rehab Prevention • Pain-free range of motion of AC joint must be present before returning to sports • Rehab exercises can help re-strengthen joint • Taping of AC joint can support and protect joint by applying pressure to clavicle • Shoulder supports and braces are available • If pain persists: patient can use ice and anti-inflammatory medication to reduce pain