AC JOINT RECONSTRUCTION

Diagnosis

The AC joint dislocation is easy to diagnose and identify. On clinical examination, the shoulder top appears prominent in comparison to the other side.



X-ray. X-ray of both the shoulders (AP view), with weights held in the hands pulling the arm down helps in identifying this condition. The grade of injury needs to be determined as Grade 1 and 2 can be managed with conservative management. Higher grades of injury Grade 3 to 6 are usually treated with surgery.

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MRI Scan. MRI Scan helps in understanding the extent of injury to the ligaments holding the AC (Acromio-Clavicular) joint as well as the CC (Coraco-Clavicular) ligaments. This helps in determining the grade of injury. MRI Scan also helps in ruling out any other additional injuries to the shoulder joint

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Treatment

AC Joint injuries Grade 1 and 2 will not affect the functioning of the arm. Hence a broad arm sling for 2 to 3 weeks till the pain and swelling settles down would be sufficient. One needs to be aware that the point of the shoulder may appear more prominent compared to the other side permanently. However, as function of the arm is not hampered.


AC (Acromio-Clavicular) Reconstruction

Surgery is recommended in people with Grade 3 to 6 AC joint injury. AC joint reconstruction surgery is a day care surgery. It is done either as a key hole (arthroscopy) or mini-open surgery. A tight rope with fiber-tape and small titanium buttons is used. A small hole is drilled through the clavicle (collar bone) and then through the coracoid (part of the scapula - shoulder bone). The button is passed through the bones and then flipped. It is then tightened to compress the AC joint back to place. The reduction of the joint back to place is confirmed by an x-ray imaging during surgery.


AC Joint Rehabilitation

Post-surgery a broad arm sling is needed for 2 to 3 weeks. Early mobilization of the arm is recommended. From the day 1, one needs to start moving the fingers, wrist and elbow. Once the surgery site pain improves, it is recommended to start moving the shoulder. Upto 6 weeks, overhead activities are to be avoided. Rehabilitation with physiotherapy is important to get the shoulder muscle strength back and the smooth movement of the muscles. Return to active sports is expected around 4 months post surgery.

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