Therapy of acromioclavicular joint dislocation

What therapy is used for acromioclavicular joint replacement?

As with many injuries, a conservative or surgical procedure is possible for acromioclavicular joint replacement. The decision depends on the severity of the acromioclavicular joint dislocation, the symptoms and the degree of activity of the patient. Rockwood I or Tossy I injuries are always treated conservatively, as no rupture of the capsule/ligament apparatus has occurred.

Recommended therapy for acromioclavicular joint destruction is the needs-based, short-term, pain and inflammation-inhibiting use of non-steroidal anti-inflammatory drugs (NSAIDs, e.g. diclofenac or ibuprofen) in combination with a local, also pain-relieving ice treatment (cryotherapy) of the acromioclavicular joint. In the case of severe movement pain, the acromioclavicular joint can also be immobilized for a few days in a shoulder arm bandage (e.g. Gilchrist bandage). Therapy recommendations for Rockwood II and Tossy II injuries are controversial.

While some advocate the conservative procedure as described above, possibly with somewhat longer immobilization in the shoulder arm bandage (1-2 weeks) and subsequent physiotherapy (physiotherapy), with reference to the good functional therapy results, others recommend surgery for acromioclavicular joint dislocation because they believe that the remaining malalignment leads to the development of acromioclavicular joint arthrosis. In our opinion, decisions should be made jointly with the patient in each individual case after weighing the pros and cons. Neither one nor the other approach would be fundamentally wrong.

Surgical therapy

There is consensus on the indication for surgery for acromioclavicular dislocation starting with Rockwood III or Tossy III injuries, particularly in younger, active patients or patients who are frequently required to work overhead in their profession. In these cases, a conservative approach would result in functional limitations of the shoulder. In order not to risk surgical complications, conservative therapy is recommended for older patients.

There are several surgical procedures that are used for acromioclavicular joint replacement. They differ in the way the acromioclavicular joint is stabilized. All have their advantages and disadvantages.

The reconstruction of the capsule/ligament apparatus is optional. The trend is to leave the torn structures to self-healing. In the opinion of many people, there are no disadvantages for the stability of the acromioclavicular joint.

Others prefer to suture the capsule/ligament apparatus.

  • Fastening suture: A slowly dissolving, stable thread (e.g. PDS cord) is passed under the coracoid and fastened to the end of the collarbone by setting up the shoulder joint. Advantage: No metal implantation.

    Good shoulder mobility. Disadvantage/danger: Loss of reduction (renewed ascent of the clavicle). Nerve injury (N. musculocutaneus).

  • Hook plate: A metal plate is inserted with its curved end under the acromion and its straight part is attached to the lateral clavicle end by screwing it to the shoulder corner joint.

    Advantage: Stability Disadvantage/Danger: Movement restriction of the shoulder. Possible impingement syndrome. Removal of metal necessary after 6 weeks.

  • Tension Strap: Joint stabilization is achieved with one or two Kirschner wires, which are inserted through the joint partners of the acromion and clavicle and around which a wire loop is tied at eight turns.

    Advantage: Stable. Nerve injury unlikely. DisadvantageDanger: Metal fracture.

    Metal migration. Restriction of movement.

  • Screw connection: A screw from the lateral collarbone end into the coracoid stabilizes the established acromioclavicular joint. Advantage: Stability Disadvantage/Danger: Screw loosening.

    Screw fracture. Restriction of movement. Collarbone fracture possible.