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AC Joint Seperation: Six Types of AC Joint Seperation

 


An AC joint is the short form of the acromioclavicular joint. The acromion process of the scapula meets with the clavicle and form the acromioclavicular joint. So in AC joint separation, the clavicle breaks up the connection with the scapula. The source of this injury is the fall that directly lands the individual on the shoulder. The outstretched arm is also another source of this injury. It is common in those players who are involved in contact sports .i.e. football, and hockey. The shoulder separation is another term for AC joint separation. 

Classification of AC joint separation:

There are three grades in AC joint separation, and these are:

Grade I:

In grade one, there is just a mild joint separation with the stretching of the acromioclavicular ligament. The AC ligament tore a little bit in this grade. 

Grade II: 

Grade two is the more serious condition where the whole acromioclavicular ligament is torn out. There will be more separation of joint as compared to grade one. The disturbance occurs in the clavicle position due to a small bump. And also, partial tearing occurs in the coracoclavicular ligament. 

Grade III:

 In grade three, there is the total joint separation as well as the complete tearing of the acromioclavicular ligament and coracoclavicular ligament. The tearing also occurs in the surrounding capsule. So in the absence of ligament support, the shoulder drops down under the arm's weight, and the clavicle pushes up, which causes a bump on the shoulder. It is the most severe joint separation where displacement is apparent on the clinical examination. 

So these were the three most common grades. There are also three more grades other than that, but they are sporadic cases. 

What is the sign of AC joint separation?

  1. Pain and weakness in the shoulder.
  2. Contusion or swelling in the shoulder.
  3. Little or finite shoulder movements.

Causes of AC joint separation:

The common cause of AC joint separation is a gust onto the point of the shoulder. It can also occur through a fall onto an outstretched hand .i.e falling off from a bicycle and horse. The application of severe force can tear the ligaments located underside of the clavicle. This results in the detachment of the scapula and clavicle. 

Treatment of AC Joint Separation:

Treatment options for AC joint separation are dependent on the type of injury. Type I, II, and III can be healed with non-surgical options. Type IV, V, and VI are severe cases and better treated with surgical procedures. The initial phase of treatment focuses on managing the inflammation and resting the joint. 

Non-surgical Treatment: 

Ice Therapy: Icing or cold pack on the injured joint help in controlling the inflammation. We can place the ice for just 15 minutes every four hours. The icing should apply until the swelling around the joint eases off. 

Use Sling: Sling is helpful in reducing pain.

Rest: Resting is beneficial in reducing the pain as well as swelling. It also allows the joint to heal. 

Medication: NSAIDs, .i.e acetaminophen, and ibuprofen are helpful in reducing pain. 

Physiotherapy:

To bring back the normal motion and strength of the shoulder, physiotherapy is recommended. There may be different physical therapy programs for different types of AC Joint Separation. 

Surgical Treatment: 

If non-surgical methods are not working, then we can go for the surgery. Usually, surgery is recommended for severe types of deformities. There are several surgical procedures to stabilize the separated AC Joint. Some of them are screw or suture loops. The surgeon can also place the artificial ligament. 

What to do after surgery?

After surgery, the patient should move forward into rehabilitation programs as well as physiotherapy. The physiotherapy starts with passive exercises, and the patient should not do a range of motion exercises until four weeks. While doing passive exercises, the muscle must be in a relaxed position, and the shoulder joint is moved gently. The physiotherapist also stretches the arm of a patient. 
The patient can go for active range of motion exercises after the complete healing of ligaments. And that can take up to six to eight weeks. 




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