Figure. Anteroposterior radiograph of right shoulder.
A 56-year-old man presents with right shoulder pain after a fall that occurred 2 weeks ago. He has had significant pain after the fall and is having difficulty lifting his arm. The patient has a slight bump on top of his shoulder; however, his pain and range of motion are improving over the last week (Figure).
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The radiograph shows that the patient has sustained a grade III acromioclavicular (AC) joint separation with 100% displacement of the distal clavicle. Grade III injuries disrupt both the coracoclavicular and acromioclavicular ligaments causing horizontal and vertical instability.1,2
These injuries are almost always treated nonoperatively. Surgical management may be considered for grade III injuries in athletes whose sport requires overhead movements, who fail conservative treatment, and who continue to have symptoms with overhead activities. One year after injury, patients can expect no difference in strength and range of motion between the injured and non-injured shoulder with nonoperative treatment. Patients have an earlier return to sports and work with nonsurgical treatment compared to surgical treatment. Surgery also brings an increased risk of complications such as wound infection and failure of fixation.1,2
Nonoperative treatment involves the use of a sling for comfort for 4 to 6 weeks. Light range of motion can be initiated with physical therapy during this time. Active reaching overhead usually begins at 6 weeks and patients often regain their overhead strength by 3 months.1,2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor in chief of the Journal of Orthopaedics for Physician Assistants.
1. Frank RM, Cotter EJ, Leroux TS, Romeo AA. Acromioclavicular joint injuries: evidence-based treatment. J Am Acad Orthop Surg. 2019;27(17):e775-e788. doi:10.5435/JAAOS-D-17-00105
2. Cook JB, Krul KP. Challenges in treating acromioclavicular separations: current concepts. J Am Acad Orthop Surg. 2018;26(19):669-677. doi:10.5435/JAAOS-D-16-00776