Do you have a sore shoulder and can’t move it well after a fall? You might have a common injury in athletes like cyclists and rugby players, acromioclavicular dislocation. But don’t panic. With the right treatment , you’ll regain mobility and be able to return to your activities.
This injury occurs when the ligaments between the collarbone and the acromion are torn. This causes these parts of the shoulder to separate. According to the Rockwood classification, there are 6 types of this injury, from less severe to more severe.
Treatment varies depending on the type of injury. For mild cases, rest and medication may be enough. But more serious cases may need surgery to fix the joint. There is an intermediate type that sometimes achieves better results with non-surgical treatment, although the shoulder may be left with a different shape.
If you opt for surgery, special plates or systems may be used. These help keep your shoulder stable while it recovers. Then, it is important to follow a recovery stage with exercises to move the shoulder well again.
Despite being a severe injury, most of those affected recover well. Some may develop long-term problems, but these are rare cases. By following medical instructions, you will be able to return to your active life without shoulder problems.
The shoulder moves around a lot, making it vulnerable to injury. One of these is acromioclavicular dislocation, caused by falls in the shoulder or strong impacts. These occur in sports or in car crashes. This injury affects a joint in the upper part of the shoulder. This area is kept stable by different ligaments. Among them, we have the coracoclavicular and acromioclavicular ligaments.
Shoulder specialists often treat acromioclavicular dislocation. This injury is most common in falls on a bicycle or motorcycle, soccer and various manual jobs. An impact to the acromion can damage the ligaments and lead to dislocation.
There are three degrees of severity in acromioclavicular dislocations. They are classified as Grade I, II and III. According to Roockwood’s classification, there are six types of acromioclavicular dislocations. For example, type III includes ligament tears between the acromion and collarbone.
Type I
Type II
Type III
Type IV
Type V
Type VI
Mild sprain of acromioclavicular ligaments, without rupture
Rupture of acromioclavicular ligaments, intact coracoclavicular ligaments
Rupture of acromioclavicular and coracoclavicular ligaments
Dislocation of the clavicle posteriorly through the trapezius
Extreme dislocation with severe deformity and avulsion of muscle attachments
Dislocation of the clavicle to the inferior below the coracoid
Contact sports and those that require rapid movement of the shoulder are the most associated with this injury. For this reason, surgery is often necessary to correct the deformity.
Acromioclavicular dislocation is common in those who play high-contact sports. It causes severe pain in the upper part of the shoulder, and there is a limitation when moving it and a different appearance than normal.
The pain is felt at the top, right at the collarbone, and becomes sharp when you move your arm. In more severe cases, a higher bone is seen from the displacement. The appearance and position of the shoulder change noticeably.
To diagnose acromioclavicular dislocation, X-rays are key. They help see how far apart your collarbone and acromion have become. The most common projections are anteroposterior and axillary. Sometimes, more tests such as MRIs or CT scans are needed for an accurate diagnosis .
The Rockwood rating is very helpful in knowing how severe the dislocation is. You look at the displacement shown by the X-rays. It also assesses how the ligaments are doing. Its use is very frequent in these cases.
Type I
Type II
Type III
Type IV
Type V
Type VI
Ligaments stretched, not completely ruptured
Partially torn ligaments
Completely torn ligaments, increased damage to coracoclavicular ligaments, joint capsule and possible injury to the deltoid muscle
Posterior displacement of the clavicle
Severe separation, possible neurovascular abnormalities
Inferior clavicle displacement, very rare, requires unique treatment strategies
Comparing X-rays with and without loading is essential. It helps to better understand the injury and know how to treat it. Treatment may be conservative or, in cases of athletes or manual laborers, require surgery.
After suffering an acromioclavicular dislocation, the first goal is to reduce pain and swelling. They also seek to fix the joint so that it recovers better. For minor injuries, treatment that does not require surgery is followed. On the other hand, for more serious injuries, the operation may be necessary.
In the initial stage, absolute rest is crucial so as not to worsen the pain. Wearing a sling helps keep your shoulder at peace and amines the risk of further damage. Pain relievers are prescribed to reduce inflammation and pain. Many times, acromioclavicular dislocation injuries are fixed with this approach, without the need to go to the operating room.
It’s normal to have trouble sleeping the first few days. Pain and awkward position can be the causes. It is suggested to sleep with the torso slightly elevated and use local cold. This helps decrease swelling and pain, improving rest.
After the dislocation is diagnosed and evaluated, the treatment plan is chosen. Recovering without surgery can take anywhere from 8 to 16 weeks, depending on the injury. It is vital to follow medical recommendations and do rehabilitation exercises. This helps in a faster recovery and prevents future problems.
The final treatment for acromioclavicular dislocation is decided according to the Rockwood classification. This classification describes 6 degrees of displacement. Let’s see which therapy is recommended for each case.
For type I and II dislocations, the recommended method is conservative. This means not performing surgery. The patient wears a sling to immobilize the shoulder for about 3 weeks. Then, the recovery phase begins, which includes shoulder exercises . Most of these cases, especially the mildest ones, resolve without surgery.
Types IV, V and VI, with more displacement, require surgery. The goal of the operation is to put the bones back in place and stabilize the joint. In surgery, the affected ligaments are repaired or reconstructed. There are several effective surgical techniques , such as open reduction . Hook plates or suspension systems are also used to stabilize.
Type III dislocation is a topic of debate in treatment. Some studies suggest surgery to recover faster, but it can leave a deformity. Recent analyses favor not operating, especially for young or very active patients. Treatment without surgery usually works well and is cheaper. If surgery is rarely needed afterward, it may have a similar outcome to if it is done as a first option.
In conclusion, therapy for acromioclavicular dislocation varies depending on its type. Type I and II are treated without surgery, while IV, V and VI require intervention. For type III, the decision between operating or not is made considering the profile of each patient.
Surgical treatment seeks two things: to reduce the joint and to stabilize the bone. There are several techniques that work well for this injury. For severe cases, open surgery with a hook plate is advised.
The hook plate helps the patient recover quickly. Sometimes, it needs to be removed later. A suspension system is also used to help the stability of the joint.
More than 85% of those treated surgically see improvements with a minimally invasive technique. The technique to be used depends on the type of dislocation, the age of the patient and their other injuries.
Hook plate
Clavicle-coracoid suspension
Type IV, V and VI dislocations
Type III and IV dislocations
Fast recovery, stability
Restores joint stability
One study showed that 52% of injuries were from falls from height. 47% were due to falls from two-wheeled vehicles. In addition, 85% of those affected were men, with six times more cases than in women.
After surgery, patients can move their shoulder little by little. Effort and sport should be avoided for 2-3 months. Rehabilitation is very important for good results.
After an acromioclavicular injury, you face a recovery process. This is key to getting back in shape and avoiding risks. In many cases, care without surgery goes a long way. But, if the dislocation is serious, they are likely to operate to fix it.
At first, protecting the shoulder with a sling is essential. You should use it for about 10 to 15 days. This gives time for your tissues to heal without complications. Avoid hard movements so as not to hurt further.
After the resting time, it is time to move your shoulder gently. The first exercises are passive mobility. They are done by a physiotherapist. This slows down stiffness and maintains flexion. Physical therapies and these exercises are the beginning to heal you.
As you feel better and feel less pain, the exercises are more active. First, with the help of the physiotherapist to achieve better movement. Little by little, without help, you move forward.
Some exercises that are classic in this therapy are:
Recovering from a dislocation takes several weeks to months. To regain control and strength in your shoulder, you need at least four to six weeks. Deciding when to return to your activities is up to the individual.
It is crucial that you follow the recommendations of your physiotherapist. Progress slowly in your recovery. This will prevent new injuries. To prevent future dislocations, you should strengthen your muscles and take care of yourself if you practice sports.
No surgery
With surgery
The pain goes away in three weeks in most cases
After the operation, it takes 8 to 16 weeks to fully recover
In short, recovering from a dislocation takes time and effort. Follow the instructions to the letter, from rest to the active phase, and you can get back to normal without problems.
Acromioclavicular dislocation injury is commonly successfully treated to return to physical activity. Recovery time varies greatly, from weeks to months, depending on the severity of the injury. Most patients with mild injuries (grade I and II) do not need surgery.
Sometimes, complications such as osteoarthritis or deformities that need surgery can occur. In chronic cases, surgery to remove part of the collarbone and reinforce it with a graft usually gives good results.
The time to return to physical activity varies depending on each case, from easy to several months. To prevent relapses, it is crucial to strengthen your shoulders and wear protection in extreme sports. With good treatment and rehabilitation, most return to their previous sporting level.
Acromioclavicular dislocation occurs when the ligaments between the collarbone and acromion rupture. This causes those parts of the shoulder to separate.
Those who suffer from it feel pain in the front of the shoulder and see a deformity. In severe cases, the tip of the collarbone may be elevated.
The diagnosis is made by looking at the symptoms and doing an X-ray. It shows how far apart the collarbone and acromion are. The Rockwood classification distinguishes 6 types according to severity.
At first, rest should be taken and a sling should be used to soothe the pain and prevent further damage. Anti-inflammatory medications are also taken to reduce swelling. The first few days are difficult because of the pain and can disrupt sleep.
Definitive treatment varies depending on the type of injury. Type I and II are cured without surgery. On the other hand, types IV, V and VI require surgery. Type III can be treated in both ways.
The surgery is intended to leave the joint stable. It is proposed to perform open reduction and put a hook plate in serious cases. Sometimes, this plaque must be removed later.
After surgery, a sling should be worn for 10-15 days. Then, the mobility exercises begin. First, passive, then assisted and finally active. The process is similar to recovering from shoulder instability.
Most people recover very well. But, in some cases, problems such as chronic pain may remain. In these cases, surgery may be needed.
