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9.04 Acromio-clavicular joint separation


Presentation

The patient fell on the point of the shoulder. He may come in right away because it hurts even without movement (first or second degree tear), or he may come in days later without pain, having noted that the injured shoulder hangs lower or the clavicle (collar bone) rides higher (third degree).

What to do:

What not to do:

Discussion

A partial tear of the ligaments between acromion and clavicle produces pain but no widening of the joint (first degree tear). A second-degree A-C separation shows up on x ray a widened joint, but is otherwise the same on examination and treatment. In a third-degree or complete separation, the ligament from the coracoid process to the clavicle is probably also torn, allowing the collarbone to be pulled superior by the sternocleidomastoid muscle, but often releiving the pain of the stretched A-C joint. Long-term shoulder joint stability and strength remain almost normal, but patients may desire sugical repair to regain the appearance of the normal shoulder or the last few percent of function for athletics.

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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
Jon Handler, MD
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