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DIAGNOSIS:

[A]. Superior Acromiocalvicular Ligament
[B]. Inferior Acromiocalvicualr Ligament
[C]. Coracoclavicular Ligament

Acromioclavicular joint (ACJ) injuries are especially common, in individuals involved in contact sports like hockey, football and occur following fall on the shoulder with an adducted arm.

The important stabilisers of the AC joint are the superior and inferior acromiocalvicular ligaments, the coracoclavicular ligaments and the trapezius and deltoid muscles.
The coracoclavicular ligament complex, main stabiliser to AC joint has two components, the more medially lying conoid and the lateral trapezoid ligaments.

Rockwood classification is most commonly used to grade the acromioclavicular joint injuries. The injuries are graded on the basis of which stabilisers are involved and the severeity of injury to the structures.

Midest is the injury to AC ligaments, followed by involvement of the coracoclavicular ligaments and the deltoid and trapezius muscular attachments in that order. 

The findings that require mention and decide management in cases of AC joint injury:

  1. Ligaments injured, i.e. superior/inferior AC ligament, coracoclavicular liagament.

  2. AC joint separation.

  3. Degree of superoinferior / anteropoosterior subluxation of the clavicle with respect to the acromion and the coracocalvicular separation.

  4. Deltoid/trapezius injury.

  5. Any osseous injury.

  6. Glenohumeral joint alignment

Coracocalvicular distance more than twice the normal i.e >25 mm, or posterior dislocation of calvicle into trapezius, indicates the need for surgery, though it is a combination of clinical assessment of stability and extent of other injuries which decides the final and most prudent line of management.

References:


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