Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

Featured on Channel NewsAsia

Acromio-Clavicular Dislocation

SYMPTOMS

There is acute onset of localised swelling and pain over the acromio-clavicular joint with or without immediate deformation.

AETIOLOGY

This injury can occur after a direct trauma or tackle to the shoulder or after a fall on to an outstretched arm. It is common in rugby, ice hockey or riding and cycling. A Grade I injury is a partial ligament tear; Grade II, one with added slight deformation or lifting of the distal clavicle end and easily reducible; Grade III, a complete tear with significant lifting, which is still easily reducible; Grades IV–VI, anterior or posterior dislocation that cannot be reduced and possibly a fracture.

CLINICAL FINDINGS

There is localised tender and fluctuating swelling over the acromio-clavicular joint and, depending on the grade, a ‘loose’ clavicle end and typical deformation. Cross-body test is positive.

INVESTIGATIONS

This is a clinical diagnosis. X-rays should be taken in different planes to rule out fracture and demonstrate the severity of dislocation by adding slight traction to the arm. MRI or ultrasound will confirm the diagnosis.

TREATMENT

For Grades I-III this injury usually responds to conservative treatment including cold and compression and an 8-bandage to hold the acromio-clavicular joint in position for three to five weeks. There is seldom any indication for surgery for these grades. Some Grade III injuries and most Grade IV–VI injuries will require surgery. Surgery for this injury may not always be straightforward and should be handled by a shoulder specialist.

REFERRALS

Refer to Dr Kevin Yip (+65 9724 1219) senior consultant orthopaedic surgeon to determine the grade of injury and consideration of surgery. Refer to physiotherapist for functional assessment and rehabilitation.

EXERCISE PRESCRIPTION

Many sports and activities, such as running and water exercises, can be maintained but avoid further direct or indirect trauma to the acromio-clavicular joint.

EVALUATION OF TREATMENT OUTCOMES

Return to normal clinical symptoms and signs. Healing usually takes six weeks for Grades I–III but more severe injuries, requiring surgery, may bar a player from contact sports for three to four months.

DIFFERENTIAL DIAGNOSES

Fractures must be ruled out, in particular upper rib fractures which can be complicated by pneumo-thorax or sternoclavicle injuries.

PROGNOSIS

Good-Fair depending on the severity. Grade I and above will result in a persistent slight deformation but no loss of function.

Leave a Reply

You can use these HTML tags

<a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>