Posted by: jbiggars63 | April 10, 2012

Successful Surgery!

Acromioclavicular dislocation (more commonly called AC separation) refers to separation of the collarbone (clavicle) from the highest point (acromion) of the shoulder blade (scapula). This injury is often confused with a dislocation of the shoulder (glenohumeral dislocation), which is actually a separation of the bone of the upper arm (humerus) from the socket in the shoulder blade (glenoid cavity of the scapula). The acromioclavicular joint capsule is made up of several groups of ligaments that stabilize the joint and allow motion.

Dislocation of the acromioclavicular joint is usually the result of a downward force applied to the acromion from a fall directly onto the shoulder or on to an outstretched arm. In this type of injury, the clavicle remains in place while the scapula is driven down, resulting in a tear to one or more ligament groups in the acromioclavicular joint capsule. Injuries to the AC joint are graded from I to VI depending on the degree of ligament damage and the resulting separation of the joint. Grades I and II are more commonly called sprains of the AC joint, incomplete dislocation, or subluxation. Grade I injuries typically involve stretched or partially torn AC ligaments and joint capsule. Grade II injuries are caused by more significant forces, and the AC ligament and joint capsule may rupture. Grades III, IV, V, and VI constitute a true dislocation. Grade III injuries involve tearing of all ligaments, resulting in complete AC joint dislocation. Grades IV through VI also involve a complete dislocation, and may additionally include injury to the surrounding muscles (muscle strains or muscle tears). The clavicle can pierce the muscle around the shoulder (trapezius) when dislocated. An AC dislocation disrupts shoulder function, limiting arm motion. Instability of the joint may cause deformity when the lateral end of the clavicle rises higher than the acromion.

Other injuries sustained from a fall or blow directly on the shoulder may include tears in deltoid and trapezius muscles attached to the clavicle; fracture of the acromion, clavicle, or scapula; and disruption of the articular cartilage of the AC joint. Shoulder injury from falling onto an outstretched arm is more likely to result in a humeral neck fracture or glenohumeral joint dislocation, and a heavy object falling on the shoulder is more likely to result in a fracture than dislocation.

Grade IV through VI injuries are treated surgically with open reduction internal fixation (ORIF), a surgical procedure that realigns the bones and reconstructs the ligaments. Screws, wires, or non-absorbable sutures may be used to hold the joint in place while the reconstructed ligaments heal. During the healing phase, shoulder motion is increased gradually to restore full range of motion. The individual usually regains full use of the shoulder about 10 weeks after surgery. ORIF usually leaves a scar about 2 inches long over the AC joint.

Any surgical procedures for AC dislocation must accomplish three objectives: 1) expose and remove any damaged tissue from the AC joint (débridement), 2) repair torn and damaged ligaments, and 3) achieve a stable reduction of the AC joint. Arthroscopic techniques using fiber-optic instruments and a smaller incision have been used for AC joint fixation with good results (Canale), but most orthopaedic surgeons prefer open procedures. I had arthroscopic surgery and I know someone that had the same thing done and was playing in a golf tournament 8 weeks afterwards so we will see!  Slow and easy to begin with though!

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