AC Separation

Right shoulder X-Ray showing acromioclavicular (AC) separation (red arrow).

Rockwood classification for AC Joint Seperation

What is AC Separation? And how does it happen?

The acromioclavicular (AC) joint is a fibrocartilaginous joint in the shoulder where the clavicle (aka collar bone) and the acromion (part of the shoulder blade) meet, providing stability in the shoulder.

It is the only joint in the upper extremity physically connecting the shoulder girdle to the axial skeleton, serving as an important role in shoulder stability.

Injury to the AC joint can result from direct trauma to the shoulder such as in contact sports injuries or from a direct fall on the shoulder.

It is possible for the capsular ligaments and/or the coracoclavicular ligaments to stretch or tear leading to separation of the the AC joint.

The degree of separation can be assessed by physical examination and X-Ray for which Dr. Urband will use to guide a treatment plan.

Who gets this injury?

AC separation commonly occurs in athletes who participate in contact sports such as football, rugby, and soccer. Sports with high velocity or risk of fall from heights, such as downhill skiing or gymnastics also pose a risk of AC joint injury. Males are more likely affected by this condition than females.

What are the symptoms? And how can my doctor tell if I have this condition?

The symptoms of an AC separation include pain, weakness, bruising, swelling, limited range of motion, and potentially a visible deformity of the shoulder in more serious injuries.

Through physical examination and imaging, your provider can determine the grade of AC joint separate and further guide treatment plans. Grade I-II and some grade III separations can be treated non-operatively, while grade IV+ separations often require operative management.

What is the anticipated recovery time?

Recovery for AC separation depends largely on the classification of injury, and severity of ligament damage. It also depends on the age and activity level of the patient, as surgery is more likely to be considered for younger, more active patients and for those with higher grade injuries.

Nonsurgical treatment is typically consists of activity modification, inflammation reduction with NSAIDs, ice, and brief sling immobilization. Grade I-II injuries should typically regain functional mobility by 6 weeks and return to full function by 12 weeks.

Higher grade AC injuries requiring operative management will require a longer immobilization time and full return to function by 6 months can be generally expected.

What are the complications of AC joint separations?

While most low grade AC joint injuries can be successfully treated non-operatively, complications that may arise include persistent pain and residual functional deficits. It is important to receive a thorough physical examination by a health care provider to identify and prevent any potential complications that may require further medical management.

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Sources

Attribution for Images

1. Cox, Jay F. “AC Separation XRAY (enhanced)”. Wikimedia Commons, 11 November 2006, https://commons.wikimedia.org/wiki/File:AC_Separation_XRAY_(enhanced).png.

2. OpenStax College. “Shoulder Joint”. Wikimedia Commons, 19 May 2013, https://commons.wikimedia.org/wiki/File:914_Shoulder_Joint.jpg.

3. https://www.radiologymasterclass.co.uk/tutorials/musculoskeletal/x-ray_trauma_upper_limb/acromioclavicular_joint_x-ray

4. Public Domain