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Type V AC joint injuries

Feb 16, 2021

Treatment for patients with Type V AC joint injuries

An Acromio Clavicular disengagement is a traumatic dislocation of the joint in which an uprooting of the clavicle happens with respect to the shoulder. Type V is a complicated injury where the delto-trapezial belt is detached from its joining point.

The clavicle is uniquely raised, and Coraco-Clavicular distance is more than double than usual (i.e.,>25 mm). The reciprocal weight-bearing perspective can expose Rockwood Type V Acromio Clavicular joint wounds.

  • AC tendon: ruptured
  • CC tendon: ruptures
  • Joint capsule: ruptured
  • Deltoid muscle: detached
  • Trapezius muscle: detached

The AC joint wounds are generally expected in people who support a fall and land outwardly on the shoulder or their hand, such as a football player who is handled, a bicyclist who crashes, or an worker tumbles off a stepping stool.

The AC joint wounds are evaluated from mild to severe, depending on the separation of the joint. Treatment of mild cases probably will be given by a physiotherapist; more severe cases may require a medical procedure followed by a rehabilitation process.

Symptoms:

  • General shoulder pain and swelling.
  • Swelling and delicacy over the AC joint.
  • Loss of shoulder strength.
  • A noticeable bump over the shoulder.
  • Pain when lying on the elaborate side.
  • Loss of shoulder movement.
  • A popping sound or getting sensation with movement of the shoulder.
  • Discomfort with everyday exercises that pressure the AC joint, such as lifting objects overhead or reaching across the body.

Diagnosis:

Diagnosis of an AC joint injury begins with an exhaustive review of the patient’s clinical history, including detailed inquiries concerning when the pain started and what elevates and calms the pain.

The physiotherapist will look at the shoulder and evaluate various measures, for example, sensation, adaptability, strength, movement, delicacy, and swelling. Diagnostic imaging, for example, ultrasound, x-ray, or MRI, is frequently used to affirm the analysis and decide the severity of the wound.

Treatment:

Non-operative treatment is suggested for type I, II, and III AC joint injuries. For type IV and V, surgery is strongly suggested.

Surgical treatment:

There are several surgical methods, but the four most common surgical options are:

  • AC joint fixation using hook-plates
  • Coraco-acromial ligament transfer
  • Coraco-clavicular interval fixation
  • Coraco-clavicular ligament reconstruction

Post-surgical management for type IV and V:

  • Apply cool packs to the worked shoulder to diminish pain and swelling.
  • Remove the sling a few times each day: move the elbow, wrist, and hand. Do pendulum practices for 3 to 5 minutes each 1 to 2 hours.
  • To wash under the worked arm, twist around at the abdomen and let the arm to lean away from the body slowly.
  • Protocols on dynamic movement and sling use will fluctuate according to the physician and wound.

Physiotherapy:

  • The physiotherapists observe the scope of movement and devise an exercising regime that helps the condition.
  • After the physical injury, balancing the upper body muscles’ solidarity is essential as it will ensure that the shoulder joint moves efficiently.
  • The physiotherapists will delicately move and prepare the shoulder joint and encompassing muscles to improve their movement, adaptability, and strength.
  • Pain Management.
  • There is a requirement for functional training, educating the whole shoulder to work best in various positions. The physiotherapists will have the option to right the movements to assist with a pain-free shoulder.
  • Most importantly, rest and the importance of it is taught to the patient.
  • Be mindful of the body aches and pain that follows.
  • Do not overdo the muscles.

Conclusion:

AC joint injuries are commonly inflicted on a sportsperson. However, the treatment is another matter. The initial three kinds of ACJ injury require physiotherapy. In any case, the later kinds require surgeries alongside physiotherapy.

References:

Attar, A., Frank, R., Team, O., Waterman, B., Gokkus, K., & McKee, M. (n.d.). Acromioclavicular Joint Injury. Retrieved December 21, 2020, from https://www.orthobullets.com/shoulder-and-elbow/3047/acromioclavicular-joint-injury

Mataich, M., Dobbeleer, M. D., Jackson, K., Cornish, S., & Malkauskaite, I. (2020, June 29). Acromioclavicular Joint Disorders. Retrieved December 21, 2020, from https://www.physio-pedia.com/Acromioclavicular_Joint_Disorders

Mumbleau, A. (2020, August 18). Physical Therapy Guide to Acromioclavicular Joint (AC Joint) Injuries. Retrieved December 21, 2020, from https://www.choosept.com/symptomsconditionsdetail/physical-therapy-guide-to-acromioclavicular-ac-joint-injuries

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