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Type I – mild, unseparated sprain of the AC ligaments with no disruption of the coracoclavicular ligaments.
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Type II – complete disruption of the AC ligaments with joint separation (less than 4 mm or 40% difference) and sprained but intact coracoclavicular ligaments.
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Type III – complete disruption of AC and coracoclavicular ligaments with joint separation and inferior displacement of the shoulder complex.
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Type IV – complete disruption of AC and coracoclavicular ligaments with posterior displacement of the clavicle through the fibers of the trapezius, and detachment of deltoid and trapezius muscles from the distal clavicle.
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Type V – complete disruption of the AC and coracoclavicular ligaments with significant inferior displacement of the shoulder complex from the clavicle as compared to a typical Type III injury.
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Type VI – complete disruption of the AC and coracoclavicular ligaments, and the clavicle has dislocated inferiorly, below the coracoid process.
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- Fall onto the shoulder with arm in an adducted position
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- FOOSH/Elbow
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- Makes up 40-50% of athletic shoulder injuries at 2-4th decade of life
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- Rugby, Ice hockey, football, wrestling players are more susceptible
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- Pain and swelling on anterosuperior aspect of the shoulder after trauma
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- Symptoms start in the traps,shoulder and neck but move to the AC joint
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- Painful with bench pressing, dips or laying on the affected side
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- Bruising/defomity on clavicular prominence
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- Swelling, bruising and deformity on clavicular prominence
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- Tenderness over AC
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- Feeling of giving way on palpation of distal clavicle (+ve Piano Key sign)
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- ROM painful and limited - abduction most affected
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- +ve Cross body adduction
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- +ve BvR
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- +ve Paxino
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- +ve Buchberger test
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- Associated with fractured clavicle, impingement syndromes and neurovascular insults
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- Clavicular f#
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- Rotator Cuff lesion
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- Shoulder Anterior impingement syndrome
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- Shoulder dislocation
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- Labral injury
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- Osteolysis of distal clavicle
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- Neoplasm
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- Rheumatologic disease
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- Cervical spine/viscerosomatic referral
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- Shoulder osteoarthritis
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- Adhesive Capsulitis
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- Erb Duchenne
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- Septic Arthritis
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- CRPS
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Grade I + II - Protection, immobilisation (sling for 3-10 days), mobility and strengthening
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- Passive mobility exercises (avoid exercises that involve behind back internal rotation, crossbody adduction and forward elevation)
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- Strengthening (closed chain scapula stability exercises - scapula clocks
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- Prognosis is favourable
- Usually regains motion by six weeks and regain normal function within 12 weeks |
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- Surgery for IV-VI types (six week immobilisation with up to six months recovery time)
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- AC joint arthritis and joint pain can occur in future
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- Type III-VI should have regular appointments by a orthopaedic surgeon/physician
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