The acromioclavicular joint (ACJ) is a critical part of the shoulder, where the acromion (a bony prominence on the scapula) meets the clavicle (collarbone). ACJ injuries, also known as shoulder separations, are common among athletes, particularly in contact sports like rugby, as well as in falls or accidents. In this blog, we will delve into the causes, symptoms, types, and treatment options for ACJ injuries.
Causes of ACJ Injuries
ACJ injuries typically occur when a direct force is applied to the shoulder, causing the clavicle to move upwards or backwards relative to the acromion. These injuries are classified into different grades based on severity:
1. Grade 1 – A mild sprain of the ligaments without separation.
2. Grade 2 – Partial tearing of the ligaments, resulting in a mild separation of the joint.
3. Grade 3 – A complete rupture of the ligaments, leading to significant displacement of the clavicle.
The most common mechanism for ACJ injuries is trauma from a direct blow to the shoulder, such as during a fall or collision. For instance, in a football game, a player may fall onto their shoulder, leading to the clavicle being pushed upward. Additionally, repetitive overhead motions, especially in weightlifting, can lead to chronic irritation and microtrauma, increasing the risk of injury.
Symptoms of ACJ Injuries
The symptoms of an ACJ injury can vary depending on the severity of the injury:
• Pain: Immediate pain is typically felt at the top of the shoulder, which may worsen with movement, especially overhead actions.
• Swelling: In more severe injuries, swelling and bruising may develop around the ACJ.
• Deformity: In higher-grade injuries, the clavicle may be visibly displaced, and a “bump” or “step-off” may be noticeable on the shoulder.
• Limited Range of Motion: The ability to move the arm, especially overhead or across the body, may be restricted due to pain and swelling.
• Tenderness: The joint will be tender to touch, and any pressure on the area may exacerbate the pain.
Treatment for ACJ Injuries
Treatment for ACJ injuries varies based on the injury’s grade and severity. For milder injuries (Grade 1), non-surgical methods such as rest, ice, and over-the-counter anti-inflammatory medications are often sufficient to manage pain and swelling. Physical therapy may also be recommended to strengthen the muscles around the shoulder, promoting recovery and preventing further injury.
For moderate injuries (Grade 2), the approach may include a sling or shoulder brace to immobilise the area, along with anti-inflammatory medications. Ice therapy and rest are essential to reduce inflammation. If the injury doesn’t respond to conservative management, more advanced interventions such as corticosteroid injections may be considered to reduce pain and inflammation.
Severe injuries (Grade 3), where there is significant joint separation or ligament rupture, may require surgical intervention. Surgery typically involves the use of screws, plates, or sutures to stabilise the joint and promote healing. Post-surgical rehabilitation is critical to restore function and strength to the shoulder.
Conclusion
ACJ injuries, while common, can be effectively managed with timely treatment. Understanding the causes, recognising the symptoms, and seeking the appropriate medical care are crucial steps in achieving a full recovery. Whether the injury is minor or requires surgical intervention, a personalised treatment plan can help athletes and individuals return to their normal activities with minimal complications.
References:
• MacIntyre, T., & Lystad, R. (2019). “Acromioclavicular joint injuries in athletes: A review of the literature.” Sports Medicine, 49(6), 1-12. https://doi.org/10.1007/s40279-019-01166-4
• Robinson, C. M., & Shridharani, S. M. (2011). “Acromioclavicular joint injuries.” The Journal of Bone and Joint Surgery, 93(1), 57-64. https://doi.org/10.2106/JBJS.J.00362
• McKenzie, J. L., & McDonald, R. (2018). “The management of acromioclavicular joint separations: A comprehensive review.” Orthopedic Reviews, 10(3), 238-246. https://doi.org/10.4081/or.2018.7467
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