AC Joint stabilisation
Acromioclavicular (AC) joint stabilisation is the process used to fix collarbone dislocations also known as AC joint dislocations.
AC Joint stabilisation
Acromioclavicular (AC) joint stabilisation is the process used to fix collarbone dislocation.
What is AC joint separation?
AC joint separation is the dislocation of the clavicle (collarbone) from the acromion or scapula. The AC joint is stablised by two sets of ligaments; the coracoclavicular ligaments and acromioclavicular ligaments. Trauma to the shoulder – caused, for example, by a fall directly onto the joint or onto the outstretched hand can result in torn ligaments. There are several types of AC joint injury classed by severity, ranging from a sprain of the ligaments that heals within weeks to complete tearing of both sets of ligaments which leads to dislocation. The best treatment option for the condition depends on the extent of your injury and your clinical examination. AC joint injuries are common and make up 9% of injuries to the shoulder girdle.
The symptoms of AC joint separation are typically pain located directly over the AC joint. Depending on the severity of the injury, there may be a small deformity and swelling on top of the shoulder. In mild injuries a bone may protrudes under the skin. In severe injuries, limited or lost range of motion in the shoulder and arm is also common, as is weakness and discomfort.
The diagnosis of AC joint injuries begins with a detailed history and clinical examination. It is common for patients to have a history of falling directly onto the shoulder. Dr Cheriachan will feel for signs of separation in the bones and soft tissue, and once the separation is confirmed, clinical examination will determine the severity of the injury. The diagnosis is confirmed by an X-ray taken while the patient is holding a weight.
The most appropriate treatment for separated AC joints depends on both the severity of the separation and functional limitations due to the injury. In most mild low grade cases, the injury may heal on its own after resting in a sling for a few weeks. Then, a course of physiotherapy for the neck and shoulders is recommended. Severe high grade separations or those which do not improve after 2-3 weeks of non operative management often require surgery. If this is an acute injury (less than 4 weeks old) this involves reducing the dislocation and stabilising the AC joint with a suspension button fixation which is placed from the clavicle to the coracoid, and sutures between the clavicle and acromion to hold the collarbone in place so the ligaments repair in the correct tension and alignment. In chronic injuries, where the injury is more than 4 weeks old, the ligaments have already healed in an incorrect position and reconstruction with a tendon graft (which is usually taken from the knee) is required.
The most appropriate treatment for separated AC joints depends on both the severity of the separation and impact on shoulder function. In most mild (low grade) cases, the injury may heal on its own after resting in a sling for a few weeks. Then, a course of physiotherapy for the neck and shoulders is recommended. Severe (high grade) separations or those which do not improve after 2-3 weeks of non operative management often require surgery.
For acute injuries (less than 4 weeks old) this involves reducing the dislocation and stabilising the AC joint. Suspension button fixation is used to stabilise the AC joint using the clavicle (collar bone) and the coracoid. Sutures between the clavicle and acromion hold the collarbone in place so the ligaments repair in the correct tension and alignment.
In chronic injuries (more than 4 weeks old) the ligaments have already healed in an incorrect position. Reconstruction of the AC joint may be recommended with with a tendon graft, usually taken from the knee.
Full recovery is likely with the appropriately chosen treatment. Most AC joint injuries are able to be managed with non-surgical treatments.
Mild cases of joint separation generally respond well to stabilisation in a sling followed by a course of physiotherapy. Pain usually resolves in a 1-2 weeks.
Following surgery, full recovery can take up to 3 months. Acute injuries and chronic injuries can take up to 6 months with most patients will achieving full range of motion and function.
Whilst the majority of people who undergo shoulder surgery do well and are very happy with their function and result, there are risks which are specific to shoulder surgery in addition to the general risks of surgery which are listed in the FAQ section of this website.
The specific risks of AC joint stabilisation surgery is fracture of the clavicle or coracoid. Stretching of the repair over time and the development of a prominence over the AC joint can occur. Some patients can experience irritation from the button fixation which can be removed after 6 months if this is an ongoing issue. Most of these risks are low less than 5 %), but it is important to be aware of these risks before consenting to surgery. Dr Cheriahcan will discuss with you the techniques he uses to minimise these risks from occurring.
Following surgery, you will need to wear a sling 24 hours a day for at least six weeks.
Movement exercises of the hand, wrist and elbow can be started in the first 6 weeks following your procedure. Due to the lack of arm movement, it’s also important that you keep your armpit dry to avoid sweat rash or infection.
After six weeks, you will gradually increase movement in your arm and can resume driving and most activities. Most patients are able to resume strengthening and high impact exercises 3 months after surgery.
In cases of chronic AC joint repair, the rehabilitation process is a deliberately slower to allow the graft to incorporate into the bone. This can take up to 6 months to completely recover.
Preparing for your visit
Your first visit will be used to carefully assess your condition as well as gathering all related health information. It is important that you bring all relevant documents including scans and x-rays. We also ask that you wear clothing that allows freedom of movement as your visit will include a physical examination.