Introduction:
Acromioclavicular (AC) joint disorders in sports players can be divided into acute injuries, degenerative conditions, repetitive strain injuries, and various other conditions. Acute AC joint injury is sometimes called a sprain or "separated" shoulder and can be diagnosed with swelling, focal tenderness, and deformity. Diagnosing AC joint disorders due to overuse, inflammation, or chronic degeneration may be more difficult, especially if the patient has concomitant shoulder problems.
A separated shoulder occurs due to the tearing of the ligaments between the collarbone, known as the clavicle, and a section of the shoulder blade called an acromion. This tear causes the mutual connection between the collarbone and shoulder blade to loosen. Thus, they either get separated or dislocated from each other. This type of injury does not usually cause damage to the main ball-and-socket joint of the shoulder. Any individual can get affected by this condition. There is no difference based on age, physical health, ethnic background, or fitness level.
How Is It Caused?
The prevalence of AC joint pain has been reported to be between 0.5 to 2.9 per 1000 people per year. The most common cause of pain or swelling is an injury from catching oneself on an outstretched arm. Most cases reported with shoulder separation are because of a direct fall onto the shoulder with enough force, which can tear the ligaments. These injuries are more commonly observed in young people as they are frequently associated with collision sports like football, hockey, etc.
Various other causes of injury to the joint are as follows:
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Car accidents.
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Falling from a bicycle.
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Repeatedly lifting objects above the head level with poor mechanics or ergonomics.
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Situations causing a direct impact on the joint, like a fall.
What Are The Signs And Symptoms Of A Separated Shoulder?
The patient who has undergone AC injury can experience the following:
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Pain at the top side of the shoulder.
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Presence of bump or swelling on the top of the shoulder and near the end of the collarbone.
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The shoulder blade tends to move in a downward direction because of the weight of the arm and torn ligaments. This can lead to the lifting of the top end of the collarbone.
How Can It Be Diagnosed?
When you visit your physician, you will be asked about your personal history, family history, medical history, and the signs and symptoms you are experiencing. Following this, a physical examination will focus on the affected shoulder. Your doctor may ask you to undergo various tests to confirm the diagnosis and decide on the treatment plan, which includes X-rays, ultrasounds, and MRIs (magnetic resonance imaging). Also, the patient may be instructed to hold a weight in hand while performing these tests to visualize the injury more clearly in the images.
After all these examinations and tests, the doctor can diagnose the severity of the shoulder separation using a scale called the Rockwood classification of AC joint injuries. This scale ranges from type I to VI injuries from "injury limited to an AC ligament sprain; joint still in place to severe ligament detachment and joint dislocation injuries," respectively. This staging helps in accurate diagnosis and treatment plan, including guiding the patient about the time taken for treatment and prognosis.
How Can It Be Treated?
Most people will recover from this condition within two to 12 weeks without surgery.
Non-surgical Treatments: The various non-surgical treatments which can be done on these patients are as the following:
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A sling can keep the shoulder in place during the healing period.
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Ice packs and medicated drugs like Ibuprofen, Aspirin, Naproxen, or Acetaminophen can be used to reduce pain.
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Strengthening the muscles and ligaments of the shoulder can be done with the help of physical therapy or an exercise session after the healing period. Getting the physician's consent before initiating a rehabilitation program is important.
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The patient should avoid lifting heavy objects for eight to 12 weeks after healing the injury.
Surgical Treatments: Surgery may be indicated in more serious cases like type IV, V, or VI injuries on the Rockwood scale or after the non-surgical treatments have not shown improvement. The symptoms of more serious injuries include when the fingers become cold or numb, weakened arm muscles, or severe shoulder deformity.
The surgical treatments that can be considered are as the following:
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Shaving the end of the collarbone. This will help in preventing it from rubbing against the shoulder blade.
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Reattachment of torn ligaments to the underside of the collarbone.
What Are The Complications Associated With This Condition?
Although most people recover and regain the complete function of the injured shoulder, some people may experience a bump or other deformity. They can also have continuous pain, even in cases with mild shoulder separation. This can be due to the rubbing of bones against each other, arthritis, or damage to the cartilage, which acts as a cushion between the bones of the shoulder joint. You should consult your physician or specialist if you have recurring signs and symptoms or face any of the mentioned complications.
How Can It Be Prevented?
There is no sure way to prevent shoulder separation. However, being aware of the factors that can cause shoulder separation can help prevent it.
These factors have been mentioned below:
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Old age.
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Repetitive motions of the shoulder.
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Manual labor causes more force on the shoulders.
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Accidents
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Falls.
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Overuse or straining of the shoulders, especially in older adults.
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Participation in collision sports.
Conclusion:
Acromioclavicular (AC) joint disorder, which is more common in sports players, is the separation of shoulders. It can be managed conservatively and surgically, depending on the severity of the condition. Most cases heal with conservative management. The prognosis is good in most cases. Early management can assist in preventing any complications. The state is mainly associated with sports injuries, accidents, or falls, and proper rest and physiotherapy can help improve healing.
