Rupture of the acromioclavicular joint is an injury that often occurs in people involved in contact and throwing sports. The injury is quite common: it accounts for up to 40% of all sports injuries to the shoulder. The most common cause of injury is a fall on the elbow or shoulder.
Arthroscopic Surgery Center Read more
Damage to the acromioclavicular joint is accompanied by the following symptoms.
- Severe pain in the shoulder girdle.
- Swelling and hematoma in the clavicle area.
- Inability to actively move the shoulder joint.
- Bone deformation in the clavicle area.
At the first sign of injury, you should immediately consult a doctor: the injury can lead to limited mobility of the arm.
Treatment
The treatment tactics for a ruptured AC joint are chosen by the doctor based on the degree of damage to the joint and the duration of the injury.
As a rule, grade 1 and 2 damage are treated conservatively.
At the border between the 2nd and 3rd degrees of damage and at the 3rd degree, surgery is necessary.
There are several ways to surgically treat a ruptured AC joint:
- open surgery - performed through a tissue incision followed by installation of a plate;
- Our center uses arthroscopic surgery, the most modern low-traumatic operation on the ACJ with a minimal skin incision and the size of the implants.
2.What happens when the shoulder is dislocated and the joint is torn?
Symptoms of a shoulder dislocation are:
- Pain in the shoulder and forearm, aggravated by movement.
- Shoulder deformity (front or back of the shoulder depending on how the bone was displaced).
Symptoms of a joint rupture are:
- Severe pain immediately after injury.
- Pain in the shoulder and collarbone area.
- Tumor.
- Injury.
- Shoulder deformity.
You may need to have an X-ray to rule out fractures or other injuries.
Visit our Traumatology and Orthopedics page
Reasons for contacting a traumatologist and radiologist
The clavicle is a small paired bone that performs both a protective function and the function of ensuring maneuverability of the arm. At the same time, the collarbone is very fragile and is at risk of injury.
People most often seek medical help from a traumatologist with dislocations of the acromioclavicular joint, clavicle fractures, cracks, and tumor formations in the clavicle. Pain, swelling, deformation of one of the ends of the damaged bone, limited movement - all these symptoms require immediate consultation with a doctor.
Stages of disease development
Traumatologists distinguish four stages of acromioclavicular arthrosis:
- Stage I – not accompanied by any symptoms. Patients note discomfort and some pain when pressing on the area of the acromioclavicular joint, when performing sharp swings of the arms. Patients ignore the first symptoms, which is why the cartilage tissue continues to thin out - the pathology begins to progress;
- Stage II – the patient constantly experiences pain in the affected joint. The painful sensations are aching and intensify when dressing, raising your arms up, or moving behind your head. After suffering injuries, a crunching sensation occurs in the joint. The amplitude of hand movements decreases. The patient experiences severe pain when lifting minor weights, at rest;
- Stage III – formed osteophytes injure soft tissues. The affected joint hurts constantly and loses mobility. Painful sensations are difficult to relieve with medications. Patients report a feeling of frozenness in the joint. Spasms of surrounding muscles and contractures are detected;
- Stage IV – develops in the absence of adequate treatment. The pain becomes unbearable due to the destruction of the joint. Most often, patients require joint replacement.
Arthrosis of the shoulder joint - what is it?
Osteoarthritis of the shoulder joint is a degenerative-dystrophic disease of connective joint tissue, which is chronic in nature and manifests itself with stiffness, accompanied by pain of varying intensity.
The development of arthrosis of the shoulder joint is characterized by changes occurring in the synovial fluid (located inside the joint). Lack of nutrients leads to degenerative-dystrophic (destructive) changes, due to which cartilage tissue loses its properties and becomes deformed.
Over time, the bone tissue located under the cartilage becomes exposed and, subject to negative effects, becomes deformed (marginal growths form on it - osteophytes, which cause limitation or complete loss of joint mobility).
An important fact is that it is extremely necessary to diagnose osteoarthritis of the shoulder joint in the early stages, when irreversibly destructive processes have not yet occurred in the tissues of the joint. Timely contact with a specialist and initiation of treatment makes it possible to stop the progress of pathological processes, ensuring the ability to maintain the functionality of the joint for many years.
Degree of development of arthrosis of the shoulder joint
The intensity of the development of destructive processes, as well as the stage of pathological changes occurring inside the joint, makes it possible to distinguish several degrees of development of osteoarthritis of the shoulder joint.
Only the attending physician can accurately determine the existing degree of arthrosis by examining the results of an x-ray. Each degree has a number of characteristic symptoms of arthrosis of the shoulder joint.
Arthrosis of the shoulder joint 1st degree
The initial stage of development of pathological processes. Arthrosis of the shoulder joint of the 1st degree lasts for several years and is manifested by a change in the quality of intra-articular fluid.
The initial stage is characterized by symptoms such as:
- significant loss of joint endurance;
- pain during movements;
- limited mobility accompanied by pain.
Timely treatment of grade 1 osteoarthritis of the shoulder joint has a positive prognosis.
Arthrosis of the shoulder joint 2 degrees
The pain intensifies and can occur even in the absence of movement.
Arthrosis of the shoulder joint of the 2nd degree is more noticeable to the patient and has clear symptoms, the manifestations of which are easily recognizable on an x-ray.
The group of symptoms also includes clicking sounds when making movements, as well as limited mobility, accompanied by sharp pain.
Lack of treatment for stage 2 osteoarthritis of the shoulder joint leads to irreversible consequences, in particular, to a complete loss of joint mobility.
Arthrosis of the shoulder joint 3rd degree
Stage 3 osteoarthritis of the shoulder joint is accompanied by constant pain, pronounced limitation of movements and the inability to move the arm back or raise it up.
X-rays show clear signs of destruction of the articular cartilage. The surfaces of the adjacent bones are severely deformed. Treatment for stage 3 osteoarthritis of the shoulder joint is only surgical intervention, which involves replacing the joint with an endoprosthesis.
Diagnosis of arthrosis of the shoulder joint
Before starting treatment for osteoarthritis of the shoulder joint, it is important to accurately diagnose the type and degree of development of the disease. But what kind of doctor treats arthrosis of the shoulder joint?
You can contact specialists such as rheumatologist, orthopedist, arthrologist for diagnostics and diagnosis. If this is not possible, then it is enough to come to an appointment with a therapist, who will refer you to the right specialist.
To make a diagnosis, a series of tests are performed to identify the presence of diseases that provoke inflammation. In addition, an important step is examination and testing, which makes it possible to confirm/refute symptoms.
Another important diagnostic step is x-ray examination in two projections.
A set of diagnostic techniques allows you to obtain an accurate picture and prescribe competent treatment for osteoarthritis of the shoulder joint.
4.How soon will I feel better?
It depends on the nature of the injury. For a joint rupture it is approximately 6 weeks, and for a dislocation it is from 3 to 12 weeks. But these are just rough estimates. Each patient's recovery process occurs at a different speed. Some symptoms, such as joint stiffness, may remain for a while. After suffering a rupture of the joints, a small but painless unevenness may remain on your shoulder.
In the future, you will need to undergo a rehabilitation course. You can start with gentle stretching exercises and increase them over time. But don't start doing exercises without consulting your doctor. Don't rush things. Do everything gradually. People who play contact sports should be especially careful. Don't try to suddenly return to your previous level of physical activity.
How is osteoarthritis diagnosed?
Diagnosis of OPS is carried out by an orthopedic doctor, rheumatologist or traumatologist. Based on the patient’s complaints, visual examination and palpation of the affected area, he diagnoses osteoarthritis. To confirm the hypothesis, additional examinations may be required, including:
- Radiography
to detect bone spurs, narrowing of the joint space and other deformities.
- Arthroscopy.
- Magnetic resonance imaging.
- Ultrasonography.
- General blood analysis.
Taking into account the stage of the disease, the doctor prescribes individual therapy.
Rupture of the acromioclavicular joint: restoration using arthroscopy
Arthroscopy for acromioclavicular joint reconstruction is a minimally invasive procedure performed through 2 small holes so that the clavicle can be anatomically fixed in the correct position. Arthroscopy and clavicle fixation can be performed on an outpatient basis and allows full range of motion to be restored within a few weeks of the procedure. Read more about shoulder arthroscopy...
Possible causes of arthrosis of the shoulder joint
Among the most likely causes of osteoarthritis of the shoulder joint are:
- joint injuries;
- congenital developmental defects (in particular, dysplasia);
- various types of inflammation.
The shoulder is a movable element of the human body skeleton. Due to the possibility of particularly free movement, the risks of injury to this particular joint are much higher. Dislocations are one of the most common causes, which is a prerequisite for the occurrence of osteoarthritis of the shoulder joint.
In addition, the causes of arthrosis of the shoulder joint can be various types of surgical interventions, increased stress, sports and professional characteristics.
Considering arthrosis of the shoulder joint as a secondary phenomenon that develops against the background of inflammation caused by various diseases, it can be caused by:
- infections;
- metabolic/endocrine/autoimmune diseases;
- hereditary predisposition.
Damage to the acromial clavicular joint (joint). Dislocation of the CAS.
Injuries to the acromioclavicular joint are common injuries in orthopedic practice. Current literature confirms the effectiveness of conservative treatment for minor injuries. However, in case of significant displacements, surgical intervention is recommended to restore the kinematics (motor function) of the shoulder.
Most studies have focused on the use of ultra-strong synthetic materials in combination with biological grafts.
Clinical examination
As with any acute injury, if damage to the acromioclavicular joint , the doctor must carefully question and examine the patient, which will help determine the possibilities and timing of treatment, and possible consequences.
Pain in the shoulder girdle is characteristic of incomplete injuries of the acromioclavicular joint . Increased pain during palpation and when performing provoking tests indicates local damage to the joint. A decrease in pain intensity in response to injection of local anesthetic confirms the diagnosis.
With complete ruptures, pain, swelling and deformation in the joint area are almost always detected.
Diagnostics
radiography is sufficient.
in three standard projections: anteroposterior, scapular, axillary.
The Zank projection (the emitter is in the anteroposterior projection, deviated by 10-15°) allows you to determine any displacement of the clavicle. Bilateral radiographs in this projection allow comparison with the opposite joint. An increase in the distance between the upper edge of the coracoid process and the lower edge of the clavicle by 25-30% (normally it is 1.1-1.3 cm) in comparison with the healthy side is regarded as a diagnostic sign of a complete rupture of the coracoclavicular ligament.
Classification of injuries to the acromioclavicular joint.
Most injuries to this joint are the result of the application of force to the acromion process directed from below when the arm is adducted. This movement moves the entire shoulder girdle down. As a result, either the collarbone is broken or the acromioclavicular ligament complex is damaged.
Consider the Rockwood classification, which begins with minimal injuries to the acromioclavicular joint .
- Type 1 – sprain of the joint capsule and surrounding ligaments without displacement.
- Type 2 – rupture of the joint capsule and surrounding ligaments with a slight upward displacement of the clavicle, usually less than 50%.
- Type 3 – rupture of the acromioclavicular and coracoclavicular ligament complex leads to a 100% displacement of the clavicle relative to the scapula.
- Type 4 – The collarbone moves backward through the trapezius muscle.
- Type 5 – complete separation of the clavicle from the scapula with a displacement of up to 300%. This displacement occurs due to a rupture of the deltoid-trapezoid fascia.
- Type 6 – displacement of the clavicle downward and pinching it between the coracoid and acromial processes of the scapula. This type is extremely rare.
Treatment
For mild injuries of types 1 and 2, conservative tactics are the main one. The use of a supportive bandage that provides a comfortable position, alternating with the lifting of restrictions and symptomatic treatment of pain leads to excellent results. The use of corticosteroids and anesthetics may speed recovery.
Therapeutic tactics for injuries of types 4, 5, 6, on the contrary, almost always come down to surgical intervention.
Tactics for type 3 injuries are ambiguous. The general consensus is that this injury should first be treated conservatively, and in case of ineffectiveness and pathological manifestations persist for three months, surgical intervention should be resorted to.
At the moment, there are 2 types of operations - open and arthroscopic . For open operations with large access, hook-shaped plates are used (see photo 1), or structures that are installed from a minimally invasive approach (see photo 2.3.4).
Photo 1
Photo 2-3-4 Recently, the arthroscopic technique for performing plasty of the cleidocracoid ligament has been widely used. Each technique has advantages and disadvantages, but the undeniable advantage of the arthroscopic technique is its excellent cosmetic effect.
Rehabilitation and postoperative period
At the end of the operation, before the patient awakens, the arm is fixed with a tight support bandage. During the first postoperative visit, a control x-ray is performed, smooth movements in the hand, wrist and elbow joints are allowed. Movement in the shoulder joint is only in the supine position.
The support bandage is discontinued after 6 weeks, and a gradual transition to strength training is allowed by 4 months, and to contact sports by 6 months.
Conclusion
Arthroscopic reconstruction of the acromioclavicular joint is a developing method and is in its infancy. The concept of arthroscopic placement of a biological graft through or around the coracoid process using synthetic anchors is the basis of most techniques. Perhaps the most durable combination will be a free graft and a synthetic fixative, which will provide a lasting result.
3. Treatment of shoulder dislocation and articulation rupture
A dislocated shoulder should be reduced immediately. The doctor needs to place the bone back into the socket. Since the joint will swell more and more every minute, and cause more and more pain, this must be done as soon as possible. Once the bone is placed back into the socket, some of the pain will go away. You can then use conservative treatment to reduce pain and swelling. The same treatment will be carried out if the joint is torn.
To treat both injuries you will need:
- Apply ice
to reduce pain and swelling (for 20-30 minutes every 3-4 hours, for 2-3 days or more). - Use a sling or immobilizer
to prevent further damage to your shoulder until you receive medical attention. - Take an anti-inflammatory pain reliever.
Nonsteroidal anti-inflammatory drugs (NSAIDs) can help manage pain and swelling. However, these drugs have side effects - the risk of bleeding and ulcers. They should be used only occasionally, as directed by a doctor. - Perform tendon stretching and strengthening exercises
as recommended by your doctor.
For severe joint tears, surgery may be necessary to repair the torn ligaments, after which you will need to wear a cast for about six weeks. Severe shoulder dislocations may also require surgery to properly align the bones and tighten the tendons surrounding the joint.
About our clinic Chistye Prudy metro station Medintercom page!
Diagnostic methods
The earlier the diagnosis of acromioclavicular arthrosis is made, the greater the patient’s chances of slowing down the process and maintaining quality of life. To reach a correct conclusion, you will need a set of measures:
- examination by a specialist with mandatory palpation of the joint;
- CT scan is necessary to determine changes in the structure of bone tissue;
- MRI – shows the condition of cartilage, ligaments, bone elements;
- Ultrasound of the shoulder joint;
- radiography - shows a narrowing of the gap between the distal part of the scapula and the collarbone;
- blood test for markers of autoimmune disorders;
Evaluation of the examination results is the basis for prescribing one or another type of treatment and the use of physiotherapeutic methods.