pathology: AC-separation

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AC-separation (-Verrenkung, Schultereckgelenk-..)

ACG dislocation (acromioclavicular joint)

Definition of

Traumatic complete or incomplete rupture of the ACG (acromioclavicular joint) with subluxation or dislocation and overstretching and rupture of ligaments:

  1. Acromioclavicular ligament: causes horizontal instability
  2. Coracoclavicular ligaments: causes vertical instability
  3. Lig. trapezoideum, lig. conoideum: depending on the severity, vertical or horizontal instability occurs

Incidence 3-4/100,000 / a, third most common injury to the shoulder joint, 2.5-6% of all dislocations, men more frequently affected. Formerly classified into 3 grades according to Tossy, today into 6 grades according to Rockwood:

  1. (=Tossy 1): Strain to partial rupture of the capsular/ligamentous apparatus. No acromioclavicular joint instability, slight pressure pain, slight pain on movement. X-ray without clear dislocation
  2. (=Tossy 2): Partial rupture of the capsular/ligamentous apparatus(rupture of the acromioclavicular ligaments) with subluxation of the acromioclavicular joint and tearing of the coracoclavicular ligaments. Painful movement and slight subluxation of the peripheral clavicle. X-ray: widened joint space and elevation of the lateral clavicle by 1/2 shaft width
  3. (=Tossy 3): Rupture of the entire capsular/ligamentous apparatus(rupture of the acromioclavicular ligaments and the coracoclavicular ligaments) with complete dislocation of the acromioclavicular joint in the vertical plane to the cranial (acromioclavicular joint disruption), step formation. X-ray: stepping up by one shaft width (corresponds to Tossy III).
  4. Dislocation of the distal end of the claviclein the horizontal plane due to partial detachment of the deltoid fascia, tearing of the deltoidinsertion, therefore dislocation(luxation) dorsally, through and possibly into the trapezius. Very rarely also ventral(dislocation/luxation) due to tearing of the trapezius (irrelevant for classification). X-ray: dorsal translation in the axial image.
  5. Extreme clavicle elevation with extensive detachment of the muscle insertions at the lateral end of the claviclewith horizontal and vertical instability
  6. Dislocation of the lateral end of the clavicle caudally under the coracoid or under the acromion. Frequent concomitant injuries: rib fractures, clavicle fracture, lesions of the brachial plexus

ICD M43

Cause

  1. Trauma: usually a fall on the shoulder with an adducted arm, more rarely also on an abducted arm that transfers the force to the shoulder joint

Diagnosis

  1. Sono: enlarged joint space
  2. X-ray in 3 planes, possibly for lateral comparison as a shoulder total with 5-10 kg weight in the hand

Symptoms

  1. Hematoma, swelling
  2. Adducted recovery posture
  3. Continuous pain, tenderness, pain on movement, more or less significant painful restriction of movement
  4. prominent distal clavicle end
  5. Depending on the degree: Highlight: piano key phenomenon (painful, non-permanent reduction of the distal end of the clavicle possible, it jumps up again like a piano key)

Complications

  1. remaining instability,
  2. Tendency to subluxate
  3. Increased risk of osteoarthritis

Therapy

  1. Analgesics (e.g. ibuprofen)
  2. Grade 1 (Tossy), usually also 2: conservative, from 3 usually surgery (various methods, none optimal)