AC Joint Injury

AC Joint Injury
July 4, 2016

dis_ac_jAcclaimed as one of the most skilled hand and shoulder specialist, Dr. Gupta while presenting his views about AC Joint Injuries seems quite assertive, “I would suggest to seek early medical attention in AC joint injuries and return back to normal activities only when the surgery has been successful in providing a pain free movement.” Mulling over AC injuries, he says, “AC joint is the joint that lies between the collarbone and the tip of the shoulder blade. It comes across as a bony bump and is prone to injury by a direct fall onto the shoulder or direct blow sustained during contact sports. “

An MBBS and MS in Ortho from AIIMS and further studies from Germany and USA, Dr Gupta has diligently been serving patients for over a period of 25 years and has provided relief to innumerable cases with more than 6000 by surgical releases. Slowly rising above the mark as surgeon to specialist, AIIMS, Medanta and Max Healthcare have been his forte for imparting expertise medical treatment.

“A deft specialist will assess AC injury after medical and physical examination still X-ray is advisable for further clinical proof. X-ray brings out the exact severity of the damage to the joint and lays base for treatment technique to be adopted. The AC injuries vary from partial displacement to total damage of the ligaments.”

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“Though AC injuries are treated with non surgical techniques to begin with, which comprises of oral medications and therapy exercises, immobilizing the shoulder by putting it in a sling and rest from strenuous activities, it is the arthroscopic repair or open surgery to stabilize the joint which provides complete relief and mobility of the shoulder.”

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“I would suggest to be precautious after the surgery in resuming activities and strictly stick to the recommendations prescribed by the surgeon to regain complete mobility.” Winded up Dr. Gupta.


FAQ – AC Joint Injury

Stretching or tearing of ligaments in the Acromio-clavicular Joint is termed as AC Joint Injury. This can also be referred to as shoulder separations. In simple terms, it is the tearing away of the clavicle from the acromion partially or severely.
Acromio-clavicular Joint is the joint that gets formed between the collarbone (clavicle) and the tip of the shoulder blade and marks its presence as a bony bump, a little distance away from the edge of the shoulder.
AC joint is the only bony join in the body that connects it to the shoulder blade and transfers load from the arm thereof. It helps to transmit load or weight while pushing or pulling, from the arm to the trunk.
The most common causes that result in AC joint injuries are a fall onto the shoulder, elbow or hand or any direct impact sustained by the shoulder point due to contact sports.
The most significant symptom is an immediate pain all around the shoulder and a prevalent bony bump on the point of the same. The pain becomes worse when trying to lift the arm or any object.
AC joint injuries are usually evidently obvious to a shoulder specialist after a physical assessment. To further the diagnosis, an X-ray of the shoulder is recommended, also with a weight in hands to ascertain the severity of injury.
As per the severity of the injury, they are divided into Grades from 1 to 6. Grade 1 signifies sprain or mild displacement of the joint. The AC ligament is stretched or partially torn. Grade 2 refers to partial separation of the joint in which the acromio-clavicular ligaments gets completely damaged but coraco-clavicular ligaments stay intact. Grade 3 refers to total dislocation with acromio-clavicular ligaments, coraco-clavicular ligaments and the capsule surrounding the joint are completely torn. Grade 4 to 6 refer to unusual cases of total dislocations resulting out of high energy injuries such as in vehicle accidents.
For sprains and partial separations the shoulder is put in a sling to rest the joint and immobilize it for healing. The pain gradually subsides within a few weeks. For mild total separation or injuries, the shoulder is put in a sling followed by therapy exercises to provide relief. In more complicated cases surgical repair becomes essential for stabilization of the joint and healing of torn ligaments. The two surgical techniques adopted to treat severe injuries are Acromioclavicular joint stabilization surgery (open) or Arthroscopic Acromioclavicular joint stabilization surgery (keyhole) in which after making incisions, the separated joint is first reduced and then internally fixed with the help of a hook plate, wire or artificial ligament.
The success ratio of surgical treatment is usually high. More than 80% of the patients regain their lost mobility and strength after the surgery.
In cases of sprain and mild partial separation, the patients gradually recover but pain and weakness persists unless treated. Severe cases of total separation will be affected by pain, weakness, neck pain or deformity in the shoulder and inability to move it if not treated.
Any surgery might result in some unpredictable surgical complications. The probable complications that may occur after AC Joint injury surgery are infection, numbness around the surgical scar, failure in the healing of ligaments, detachment of deltoid or trapezial muscle or rare fracture of the collar bone.
Certain precautions that the patient needs to take to improve the outcome of the surgery include keeping the wound dry and clean so that it does not become infected, wearing a sling for the prescribed period for immobilization to ensure healing, avoid any rings on the operated side for a few weeks and follow a strict regime of therapy exercises.
Returning back to work or normal activities usually depends on the severity of the injury and the nature of the work that the patient has to resume. On a general basis though, the patient can resume driving after eight weeks starting with short journeys, desk work can be resumed after 10-15 days but with an advice to keep it less strenuous, swimming could be resumed only after a period of 12 weeks and lifting or manual work is usually advisable to be resumed after 10 to 12 weeks.
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