#treatment - Shoulder
- Instability of the acromioclavicular joint (ACJ) usually occurs as a result of violent trauma.
- Depending on the degree of instabilty treatment may require physiotherapy, surgery or both.
- Early surgery aims to allow the ligaments torn during the dislocation to heal in shortened position.
- Late reconstuction can be performed using either synthetic materials or tendon grafts.
- Many cases can be performed arthroscopically (key hole surgery).
- If there is a lager amount of damage to the surrounding structures open surgery may be required.
The majority of injuries to the acromioclavicular joint (ACJ), which lies between the outer end of the collar bone (clavicle) and part of the the shoulder blade (scapula) called the acromion, are sprains. These normally occur after a fall or tackle where the structures that normally control the joints stability are loaded and partially torn. Most sprains although painful will settle with time, applied ice and physiotherapy to rehabilitate the injured area. If these structures are completely disrupted and the joint is rendered unstable early surgery may be occasionally required particularly In younger patients, particularly those engaged in contact and overhead sports (Rugby, Football, Tennis). In some cases of longstanding instability of the joint reconstructive surgery may be required to restore more normal relationships between the scapula and clavicle.
The ACJ relies for stability on tough fibres surrounding the joint (capsule) and on two ligaments running between part of the shoulder blade called the coracoid and the clavicle (coronoid and trapezoid). Complete disruption of all three structures will result in instability.
The appropriate treatment choice is dependant on a number of factors including the degree of instability, how recently the injury occurred, the pattern of structures injured and the anticipated types and levels of activity that the individual wishes to undertake.
Most surgeons would agree that with sprains or minor injuries that surgery is inappropriate. Where significant disruption has occurred the options lie between early intervention (preferably within the first 2 weeks) using key hole surgery and a watch and see philosophy to assess the degree of disability caused to the patient by the injury before deciding on reconstructive surgery.