A acromioclavicular joint dislocation is the incomplete to complete tearing of the capsuloligamentous apparatus of the acromioclavicular joint. Most often, this is the result of falls in which one falls directly on the shoulder.
What is acromioclavicular joint dislocation?
The acromioclavicular joint is technically called the acromioclavicular joint; acromion means acromion, clavicle means clavicle. So, in acromioclavicular joint dislocation, there is an injury in the relatively small joint formed by the acromion and clavicle. The inner part of the joint consists of the outer side of the clavicle, and the outer part is the side of the acromion facing the center of the body. Mainly, the joint is stabilized by joint capsule and several ligaments. In this region, the ligaments and capsule are overstretched, strained or torn in acromioclavicular joint dislocation. There may also be a complete tear of the ligaments. In the shoulder girdle, acromioclavicular joint dislocation is one of the most common injuries.
Causes
The causes of acromioclavicular joint dislocation are usually direct force or falls on the shoulder area. This is mainly a typical sports injury, since here the arm is often pulled in front of the body when the fall occurs. Especially in the sports of skiing, cycling, motorcycling, martial arts and also horseback riding, a acromioclavicular joint is contracted. But also all other sports, where you run a lot, falls can lead to a acromioclavicular joint dislocation. Rarely, on the other hand, a fall on the outstretched arm is a possibility.
Symptoms, complaints, and signs
In an existing shoulder joint dislocation, severe pain in the shoulder is the most obvious symptom. Often, affected individuals also suffer from severe swelling in the shoulder region. With even the smallest movements or when pressure is applied, the pain intensifies considerably. Even at rest, this pain persists. As a result, affected individuals usually adopt a tense, protective posture. The arm is bent and supported with the healthy arm. Under certain circumstances, this tense position can even lead to back pain, which also becomes more severe as the disease progresses. If a doctor is consulted at an early stage in the event of such a shoulder joint dislocation, the symptoms that occur can be effectively and quickly alleviated. Painkillers and permanent cooling of the affected area can bring about rapid relief. The situation is different, however, if the affected person completely forgoes treatment. Then a considerable aggravation of the existing symptoms is to be expected. In particularly severe cases, the joint may even be permanently damaged and cannot be restored afterwards. A shoulder joint dislocation is accompanied by fairly typical symptoms, which can, however, be treated very well. In this case, however, it is important to see a doctor promptly, otherwise there is a risk of serious complications.
Diagnosis and course
To be able to diagnose a acromioclavicular joint rupture, a physical examination is performed and a questioning about the exact course of the injury. If there is a tear or rupture of the ligaments or/and capsule, there is a clear malposition of the clavicle; it is up (it is luxated). Nevertheless, an imaging diagnosis is inevitable in order to be able to determine the acromioclavicular joint dislocation with certainty. A deformity can be seen here, even if it is not visible externally. The acromioclavicular joint dislocation can be classified into 3 grades, usually according to Tossy (or Rockwood). Tossy I describes a tear of the ligaments, but the joint partners cannot be displaced. Tossy II is also an incomplete tear, but the two joint partners can be easily displaced. In Tossy III, the ligaments (and capsule) are completely torn and the two joint partners are clearly movable against each other. The clearly protruding clavicle can be pushed down and then comes back up (piano key phenomenon).
Complications
In the case of a acromioclavicular joint dislocation, the affected person primarily suffers from very severe pain.These occur mainly in the shoulder, but can also spread to the surrounding regions, resulting in pain in the neck or arms. Patients also suffer from severe swelling and bruising. Due to the permanent pain, many patients suffer from restricted mobility or further depression. Especially nocturnal pain can lead to irritability of the patient, which is favored by sleep complaints. The shoulders and arms can hardly be moved due to the pain. Movements of the hands can also lead to pain, so that the patient’s everyday life is considerably restricted. Sometimes it can happen that the ligaments are also torn in the case of acromioclavicular joint dislocation. However, the further course of this condition depends greatly on the exact cause and the type of accident or blow. In most cases, the symptoms can be relatively well limited with the help of physiotherapy. Those affected must refrain from sporting activities for a few weeks. No particular complications occur. The patient’s life expectancy is also not negatively affected by the acromioclavicular joint dislocation, as long as the accident does not pose a threat to life.
When should you go to the doctor?
In any case of a acromioclavicular joint dislocation, the affected person is dependent on treatment by a doctor. There can be no self-healing in this case, and the symptoms usually worsen if they are not treated. The earlier the acromioclavicular joint dislocation is recognized and treated, the better the further course of this disease. A doctor should be consulted if the patient suffers from very severe swelling of the shoulders. These swellings occur without any particular reason and do not disappear on their own. Severe and especially persistent pain in the shoulders may also be indicative of acromioclavicular joint dislocation and must be examined by a doctor. The pain can also spread to the back and cause discomfort there as well. A general practitioner or orthopedic surgeon should always be consulted for these symptoms to prevent complications. Acromioclavicular joint dislocation can be treated relatively well, and the life expectancy of the affected person is also not limited or reduced by the disease.
Treatment and therapy
Once medical treatment for acromioclavicular joint dislocation is complete, consistent and adapted physiotherapy should be performed to ensure the best possible rehabilitation. Since no surgery is necessary for Tossy I or II, light sporting activity can be resumed after the pain has subsided, but this should not involve the affected shoulder. In this case, no sports at all should be practiced for 1 to 2 weeks at first. In the case of Tossy III, the break should be about 4-6 weeks, depending on whether the acromioclavicular joint was treated conservatively or surgically. The arm should also not be splayed more than 90° from the body during this period. As an immediate measure after the fall, the arm can be stabilized on the abdomen for relief, using a triangular sling if possible. A cooling battery can also initially relieve pain and relieve swelling until a doctor is seen. With all 3 forms of Tossy, physical therapy is still important to restore free movement of the arm.
Prevention
There is limited prevention of acromioclavicular joint dislocation, as it usually involves awkward falls to the lateral shoulder region and cannot always be prevented. The risk of injury can only be reduced if appropriate protective clothing is worn. For example, a jacket with protective pads can be worn especially when riding a motorcycle, as the risk of injury is particularly high here in the event of a fall. Appropriate shoulder pads can also be worn when playing football.
Aftercare
In the case of an acromioclavicular joint dislocation, the affected person primarily suffers from very severe pain. The pain occurs mainly in the shoulder, but can also spread to the neighboring regions, so that there is pain in the neck or even in the arms. Patients also suffer from severe swelling and sometimes bruising. The permanent pain can also lead to restricted mobility or depression.Especially nocturnal pain can lead to irritability of the patient and further to sleep problems. The shoulders and arms can hardly be moved due to the pain. Movements of the hands can also lead to pain, so that the patient’s everyday life is considerably restricted. Furthermore, the ligaments may also be torn in acromioclavicular joint dislocation. However, the further course of this condition depends greatly on the exact cause and the type of accident or blow. In most cases, the symptoms can be relatively well limited by physiotherapy. Those affected must refrain from sporting activities for a few weeks. Particular complications do occur. The patient’s life expectancy is also not negatively affected by the acromioclavicular joint dislocation, as long as the accident does not pose a threat to life.
What you can do yourself
If possible, the affected person should take it easy and avoid physical exertion during a acromioclavicular joint dislocation. Sporting activities should be avoided for the period of medical treatment or should be reduced to a minimum. Since the affected person automatically assumes a protective posture due to the existing complaints, there is a greater strain on other physical regions. To avoid tension or additional pain, heat treatments or massages in the affected areas are advisable. The daily routine must be restructured and adapted to the patient’s requirements and possibilities. The completion of important physical tasks should be taken over by other people so that no overload occurs. The request for help must therefore be made by the patient to people in his or her social environment. Physiotherapeutic therapy is part of the treatment of acromioclavicular joint dislocation. The exercises and training units learned there can also be used independently outside the sessions. They support and promote the healing process. Equally important for recovery is mental strength. With a positive basic attitude and optimism, the affected person helps himself to improve the overall situation more quickly. The focus of perception should not be on the activities that can no longer be performed by oneself. It is important to acknowledge outside help as well as one’s own progress within the therapy.
