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Acromioclavicular (AC) joint Surgery

Abstract:

Acromioclavicular (AC) joint is the gathering point of the acromion and clavicle bones, regularly showed with an apparent knock nearby. Major reasons behind the injuries of AC joint are falls and other injuries that cause the roof of the shoulder to move, the collarbone to break, and the tendons to stretch or torn.

Medical procedure for AC joint wounds might include eliminating the end or reestablishing the situation of the clavicle to calm agony and permit the patient to continue typical working of the joint.

Introduction:

The acromioclavicular joint (AC) is the confluence of the acromion and clavicle, and visible ridges also lie in this area. AC joint injuries often occur as a result of falls or other trauma that causes the acromion to move or fall off the clavicle, or the ligaments to stretch or tear.

Acromioclavicular joint injury:

The injuries of this joint are often treated first with conservative treatment, but more severe or persistent pain-causing injuries may require surgery. Surgery for AC joint injury requires removal of the end of the clavicle or repositioning of the clavicle so that the pain can be relieved and the patient can resume normal functioning of the joint.

Arthroscopy procedure:

Physicians perform these procedures by arthroscopy or conventional laparotomy, depending on the nature and severity of each patient’s individual condition. Arthroscopy provides the patient with smaller cuts, shorter recovery times, and less trauma. Your surgeon will determine the type of procedure that is best for you after a thorough examination of your condition.

 

 

Causes of AC injury:

  • Often, trauma, such as a fall directly outside the shoulder.
  • Lifting heavy objects or heavy objects repeatedly overhead.
  • Fall on the side of shoulder, such as a motorcycle injury.
  • Seat belt effect
  • Age factor (more common in people under the age of 35)

Signs and symptoms:

If you have a shoulder injury (exercise, falls, overuse, etc.), there are several symptoms that suggest that the injury is affecting the acromioclavicular joint. These include:

  • Shoulder or Arm Pain
  • Tenderness at the top of the shoulder
  • Limited shoulder mobility
  • Weakness in the shoulders and arms
  • Swelling on the shoulders
  • Pain when lying on the affected side
  • The sound of popping out when you move your shoulders

Physical examination:

During physical examination, the patient must be standing or sitting. This will increase the   deformation due to the weight of the arm.  Laboratory tests may show abrasions on the shoulders and protrusions of the distal clavicle.

As a result of the downward displacement of the shoulder girdle, ecchymosis and swelling may be present in the protruding distal clavicle. AC joint palpation shows softness. Usually, the intense pain limits the freedom of shoulder movement .

AC joint pathology test:

The presence of associated injuries should always be considered. Provocative testing of AC joint pathology (acromioclavicular joint adduction and AC joint load) can help identify shoulder pain in AC joints.

These tests are particularly valuable for patients with Type I and Type II (mild) Injuries who might not have apparent or discernible distortions. Injection of selective local anesthetics helps distinguish chronic AC joint pain from other medical conditions that cause pain in the anterior or upper shoulder. However, it is rarely needed in acute injuries.

Tests:

Radiographs:

X-rays are the first diagnostic imaging method of choice for diagnosing and classifying AC injuries. As with any shoulder injury, once the patient is hospitalized, a standard radiograph is obtained. It includes anterior, posterior, lateral, and axillary view.

Axillary view:

The axillary view regularly assists with picturing the measure of back dislodging of the clavicle. The Zanca view is often helpful in case of suspect of 6 AC joint injury. It is displayed by tilting the x-rays 10 ° to 15 ° cranial as compared to the standard.

Get a shoulder x-ray. 23 You can create a weighted clavicle load view to distinguish between Type II and Type III injuries. The literature extensively supports this approach. However, it is not routinely recommended today as it does not change the course of treatment. Moreover, it causes discomfort to the patient.

MRI Technique:

MRI is not a routine imaging technique, but there is growing interest in using MRI to assess AC and CC ligament injuries.

Method of Surgery:

AC joints are one among the few joints within the body that will stay without a certain amount of the bones that form up the joint. Surgeons do the surgery by making a small incision about 1 inch (2.5 cm) long, or by making multiple small incisions using arthroscopic techniques. Regardless of the technique, recovery and results are about the same.

Recovering period after surgery:

In most cases, patients can return home with an arm sling on the day of surgery. After about a week, the seams will appear and the shoulders will begin to move immediately. It takes about 4-6 weeks to fully exercise and a few more weeks to regain strength. Recovery depends on many factors, but most patients are fully active again after 3 months.

 

                                             Grades:

 

            Grades       AC ligament      CC ligament
 l Slightly torn No damage
ll Completely torn Near to damage
lll Completely torn Completely torn
lV, V, VI AC joint injury are also possible, but rare.

The ligaments and Adjoining muscle tissue are torn.

 

Result of Surgery

Patients get excellent pain relief from this surgery, and nearly 95% return to their previous level of activity and sports. Though there are few complications, the results are good enough to satisfy most patients.

There is always the possibility of infection, but this is rare. Occasionally, patients may experience fatigue or pain when lifting heavy weights or during exercise if the shoulder is crooked. However, most patients are very happy with the surgery and may be more active than they were before surgery. As we see in diagram below

 

 

 

 

 

 

 

        Before Surgery.                     After surgery

 

Treatment:

Treatment usually includes

  • Arm slings,
  • Bed rest,
  • Ice and heat therapy,
  • Anti-inflammatory medications.

 

Duration of healing:

Most people fully recover shoulder and arm movement within 6-8 weeks, usually with the help of physical therapy.

Note: In case of an injury to your AC  joint, you may experience pain and discomfort in your daily life. This includes carrying heavy objects to the side, lifting objects above your head, reaching for your body, and so on.

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