Acromioclavicular Joint Separations

By the position of the dislocated distal clavicle.

How are AC injury Type IV-VI determined?

Reduced by having patient lay with a towel roll between scapula. Traction and abduction of the arm with slight pressure on the clavicle.

How is an Anterior SC joint dislocation reduced?

D. 40 degreees

How much cephalic tilt is there in a Serendipity view? A. 10 degrees B. 20 degrees C. 30 degrees D. 40 degrees

True

T/F: All of the different types of AC injuries will have *point tenderness* over the shoulder and loss of motion.

Serendipity View Hobbs view

What are the two views that are utilized to view the SC joint?

Force of the fall.

What dictates the degree of the injury of an AC joint?

C. Resection of the clavicle

What is the last step for treatment of an AC joint OA?

B.

What is the treatment for a Grade I SC injury? A. Closed or open reduction; figure 8 harness (4-6 weeks); return to activity in 6-8 weeks. B. Anti-inflammatory, rest(sling), ice, return to activity when full, pain free ROM is achieved. C. Figure 8 harness (7-10 days),return to contact activity when full pain free ROM (4-6 weeks) is achieved.

A.

What is the treatment for a Grade III Sc injury? A. Closed or open reduction; figure 8 harness (4-6 weeks); return to activity in 6-8 weeks. B. Anti-inflammatory, rest(sling), ice, return to activity when full, pain free ROM is achieved. C. Figure 8 harness (7-10 days),return to contact activity when full pain free ROM (4-6 weeks) is achieved.

B. Athletes

What population is SC joint injury most common? A. Children B. Athletes C. Adults D. Elder

Planar joint

What type of joint is the AC joint?

B. Grade 2

Which SC joint grade is characterized by complete rupture of SC ligament and partial rupture of costoclavicular ligament. Pain and swelling, pain with abduction. A. Grade 1 B. Grade 2 C. Grade 3

C. Grade 3

Which SC joint grade is characterized by dislocation with complete ligament disruption. A. Grade 1 B. Grade 2 C. Grade 3

D. Soccer

Which is not considered the most common sport for an AC joint injury? A. Hockey B. Lacrosse C. Football D. Soccer E. Wrestling

B. Adducted, Inferiorly

Most AC injuries occur from falling directly on the ____________________shoulder, causing the acromion to drive _________________, spraining the intraarticular AC ligaments. A. Abducted, Inferiorly B. Adducted, Inferiorly C. Abducted, superiorly D. Adducted, Superiorly

E. Both B and C

What are the dynamic stabilizers of the AC joint? A. Coracobrachialis m. B. Trapezius m. C. Deltoid m. D. Pectoralis major m. E. Both B and C F. Both A and D

C. Anterior (most common)/Posterior dislocation

What are the two classifications for SC joint injury? A. Anterior/Inferior B. Anterior/Superior C. Anterior/Posterior D. Anterior/Medial

A. Type I

This AC grade is characterized by activity modification which may include the use of a sling/immobilization until symptoms subside, enough healing time has been allowed and ROM is reasonably comfortable. Acute phase modalities as needed; Nutrition/Supplements for pain and inflammation. A. Type I B. Type II C. Type III D. Types IV, V, VI

D. Type IV, V ,VI

This AC grade is characterized by an orthopedic surgeon being consulted as soon as the diagnosis is made for surgical reduction and stabilization; return to activity depends on healing; ROM, facilitation, stabilization and strengthening exercises. A. Type I B. Type II C. Type III D. Types IV, V, VI

C. Type III

This AC grade is characterized by controversy—it can be treated in the same way as I and II but will take 6-12 weeks to heal or the Kenny-Howard Sling Halter approach. Which includes stabilization of clavicle to coracoid with a screw, resection of lateral clavicle, trans articular AC fixation with pins, use of coracoacromial ligament as substitute AC ligament. A. Type I B. Type II C. Type III D. Types IV, V, VI

Acromioclavicular ligament Coracoclavicular ligament

What are the two ligaments of the AC joint?

D. 1.3 cm

A space of what is usually indicative of a grade III separation? A. 1.0 cm B. 2.0 cm C. 1.5 cm D 1.3 cm

B. Type II

Classify the type of AC injury: Characterized by a complete disruption of the AC ligament with a torn but intact CC ligament, both instability and displacement. A. Type I B. Type II C. Type III D. Type IV E. Type V F. Type VI

E. Type V

Classify the type of AC injury: Characterized by clavicle widely displaced superiorly relative to the acromion as a result of disruption of muscle attachments. A. Type I B. Type II C. Type III D. Type IV E. Type V F. Type VI

C. Type III

Classify the type of AC injury: Characterized by complete rupture of the AC and CC ligaments. AC joint is wide and distal clavicle raised above the acromion; both instability and displacement. A. Type I B. Type II C. Type III D. Type IV E. Type V F. Type VI

F. Type VI

Classify the type of AC injury: Characterized by inferior displacement of the distal clavicle below the acromial process or the coracoid process. A. Type I B. Type II C. Type III D. Type IV E. Type V F. Type VI

D. Type IV

Classify the type of AC injury: Characterized by posterior displacement of the clavicle relative to the acromion with buttonholing through the trapezius muscle. A. Type I B. Type II C. Type III D. Type IV E. Type V F. Type VI

A. Type I

Classify the type of AC injury: Characterized by torn but intact AC and CC ligaments; no instability or displacement. A. Type I B. Type II C. Type III D. Type IV E. Type V F. Type VI

Refer to image

Refer to image

A. Internal thoracic and Suprascapular aa.

What blood supply runs directly beneath the SC joint? A. Internal thoracic and Suprascapular aa. B. Suprascapular and Thoracoacromial aa.

Sternum Clavicle Scapula Humerus

What bones make up the shoulder joints?

B. One hand on each side of AC joint and squeeze together.

What is the AC joint compression test? A. One hand over AC joint and the other supplying a downward traction at the elbow to look for pain and/or movement of the scapula inferior to the clavicle. B. one hand on each side of AC joint and squeeze together. C. Push down on distal clavicle and watch for it to pop up-coracoclavicular ligament. D. The patient places his hand on the opposite shoulder, while the examiner exerts force horizontally. Again, the presence of pain indicates possible pathology.

B. Posterior

What is the most severe type of SC joint injury? A. Anterior B. Posterior

B. Steroid injection into the joint.

What is the second step for treatment of AC joint OA? A. Treat it symptomatically with NSAIDs and activity modifications. B. Steroid injection into the joint C. Resection of the clavicle

Type I

All grades but _________have an anatomical defect.

A. 5x

How much more common is an AC joint injury in males than females? A. 5x B. 10x C. 12x

True

T/F: No muscles move the AC joint directly. The movement of the scapula causes the AC joint movement.

True

T/F: Posterior SC joint dislocations are rare, but may be life threatening.

True

T/F: The AC joint is vulnerable to injury in collision sports and in activities requiring repetitive overhead motions.

B. Type II

This AC grade is characterized by orthopedic surgeons recommending the use of a sling for 1-2 weeks or until symptoms subside. Rehabilitation emphasizing maintaining or regaining ROM. However, as the AC ligaments are disrupted, heavy lifting and contact sports should be avoided for 6-12 weeks to allow healing and prevent progression to a type III injury. A. Type I B. Type II C. Type III D. Types IV, V, VI

D. Deltoid impingement

Which is not a co-morbidity to AC OA? A. Rotator cuff degeneration/tear B. D/T intrusion of osteophytes into the suprahumeral space. C. Acts as a SOL to irritate the cuff tendon D. Deltoid impingement

D. All of the above are complications

Which is not a complication of a posterior SC joint dislocation? A. Hemorrhage B. Tracheo-esophageal fistulas that result in death approx. 4.5 years after injury C. Pneumothorax, hemothorax, brachial plexus injuries, hoarseness D. All of the above are complications

C. Push down on distal clavicle and watch for it to pop up—coracoclavicular ligament

What is the Piano key test? A. One hand over AC joint and the other supplying a downward traction at the elbow to look for pain and/or movement of the scapula inferior to the clavicle. B. one hand on each side of AC joint and squeeze together. C. Push down on distal clavicle and watch for it to pop up-coracoclavicular ligament. D. The patient places his hand on the opposite shoulder, while the examiner exerts force horizontally. Again, the presence of pain indicates possible pathology.

A. Treat it symptomatically with NSAIDs and activity modifications.

What is the first step for treatment of AC joint OA? A. Treat it symptomatically with NSAIDs and activity modifications. B. Steroid injection into the joint C. Resection of the clavicle

B. Lateral compression of the shoulder girdle resulting in a fall on the shoulder when the arm is in forward flexion.

What is the mechanism of injury for a posterior dislocated SC joint? A. Direct impact on sternum—MVA/sports B. Lateral compression of the shoulder girdle resulting in a fall on the shoulder when the arm is in forward flexion.

A. Direct impact on sternum—MVA/Sports

What is the mechanism of injury for an anterior dislocated SC joint? A. Direct impact on sternum—MVA/sports B. Lateral compression of the shoulder girdle resulting in a fall on the shoulder when the arm is in forward flexion.

C.

What is the treatment for a Grade II SC injury? A. Closed or open reduction; figure 8 harness (4-6 weeks); return to activity in 6-8 weeks. B. Anti-inflammatory, rest(sling), ice, return to activity when full, pain free ROM is achieved. C. Figure 8 harness (7-10 days),return to contact activity when full pain free ROM (4-6 weeks) is achieved.

A. Grade 1

Which SC joint grade is characterized by mild sprain with intact ligaments. Pain and swelling. A. Grade 1 B. Grade 2 C. Grade 3

K.

Which is not a S&S of a SC joint injury? A. Pain B. Swelling C. Pain with abduction or compression D. SC joint asymmetry E. Dysphagia F. Choking or tight feeling in throat G. Venous engorgement of ipsilateral arm H. Ipsilateral paresthesias I. Pneumothorax J. Head tilted towards affected side K. All of the above are S&S

Trapezoid -Prevents compression and superior translation. Conoid -Prevents superior and anterior translation.

What are the two parts of the coracoclavicular ligament? Include the function.

B. Suprascapular and Thoracoacromial aa.

What blood supply runs directly beneath the AC joint? A. Internal thoracic and Suprascapular aa. B. Suprascapular and Thoracoacromial aa.

A. One hand over AC joint and the other supplying a downward traction at the elbow to look for pain and/or movement of the scapula inferior to the clavicle.

What is the AC joint distraction test? A. One hand over AC joint and the other supplying a downward traction at the elbow to look for pain and/or movement of the scapula inferior to the clavicle. B. one hand on each side of AC joint and squeeze together. C. Push down on distal clavicle and watch for it to pop up-coracoclavicular ligament. D. The patient places his hand on the opposite shoulder, while the examiner exerts force horizontally. Again, the presence of pain indicates possible pathology.

D. The patient places his hand on the opposite shoulder, while the examiner exerts force horizontally. Again, the presence of pain indicates possible pathology.

What is the Cross-Arm Horizontal Adduction Test? A. One hand over AC joint and the other supplying a downward traction at the elbow to look for pain and/or movement of the scapula inferior to the clavicle. B. one hand on each side of AC joint and squeeze together. C. Push down on distal clavicle and watch for it to pop up-coracoclavicular ligament. D. The patient places his hand on the opposite shoulder, while the examiner exerts force horizontally. Again, the presence of pain indicates possible pathology.