Acromioclavicular joint sprains

1. What are the 3 ligaments surrounding the AC joint?
2. How do AC joint sprains usually occur?
3. What are the 6 types of AC joint sprain?
4. What sort of X-ray should be obtained for AC joint separation? What is seen?
5. What is the treatment of Type I and II AC injury?
6. What is the treatment for Type III AC injury?
7. What is the treatment for Type IV-VI AC injury?
8. What is the treatment for chronic AC joint pain?

Answers:
1. AC ligament, coracoclavicular (CC) ligament, coracoacromial ligament.
2. Direct impact to shoulder, falling on outstretched arm.
3. Type I is a partial sprain of the AC ligament with intact CC ligament. Type II involves a complete tear of the AC ligament and a partial tear of the CC ligament. Types III-VI involve complete tear of the AC and CC ligaments with varying displacement.
4. Weighted (10lb) radiographs of shoulder should be obtained. Type III injury shows 25-100% widening of clavicular-coracoid area. Type V injury may show widening >100%.
5. Rest, ice, NSAIDs, sling (comfort), avoid heavy lifting, shoulder girdle strengthening, return to play if asymptomatic with full ROM for 2 weeks if Type I, 6 weeks if Type II.
6. Controversial: surgery vs. conservative, based on need.
7. ORIF or distal clavicular resection with reconstruction of CC ligament.
8. Corticosteroid injection vs. surgery.