Early restore of shoulder AC joint key to restoration

You have a bump on your shoulder after a fall. You are told you have a split shoulder or AC joint dislocation. What are you doing now?

A shoulder separation is an injury to the acromioclavicular (AC) joint on top of the shoulder where the collarbone (collarbone) meets the highest point of the shoulder blade (acromion). Injury to the AC joint is common, and is often caused by a blow on the shoulder or a fall on an outstretched hand. The fall injures the ligaments that surround and stabilize the AC joint, forcing the collarbone to detach from the acromion. This creates a bulge or bulge over the shoulder. The shoulder and neck muscles contract a little because the shoulder no longer has the strut of the collarbone to keep it length and to ensure normal stability. Many of the NFL linemen have AC joint injury and chronic separation.

The AC joint separations are divided into different categories depending on the severity of the damage. Mild AC joint injuries (Types I and II) may respond to conservative treatment such as ice, a sling, and more physical therapy. More serious injuries (Types III, IV, V, and VI) are usually repaired surgically. If these ligaments are severely torn, they will never heal on their own because the collarbone is raised beyond the healing distance of the torn ligament. Why fix them? Because the connection between the collarbone and the acromion provides a stable strut against which the entire shoulder can lever. When damaged and dislocated, many people will notice the loss of strength and slight pain in the shoulder because it is not as stable as it was before an injury. The long-term result of a dislocated AC joint is painful arthritis on the AC joint itself, which is somewhat of a mystery as the collarbone is displaced outside the joint. However, it appears that abnormal forces and movements that temporarily cause the collarbone to interact with the acromion lead to a degenerative change over time. The early restoration of the AC joint can prevent this subsequent AC joint arthritis.

There is still some controversy over how best to treat Type III shoulder separation. Although some patients and physicians choose the nonsurgical option, athletes throwing overheads or playing tennis, volleyball, and squash are significantly weakened by a type III joint dislocation for up to a year after injury and are often mildly affected permanently. Knowing this, many of our athlete patients choose to have the injury repaired. The reason for early repair is so that newly torn ligaments can be sutured back together and secured by wrapping an allograft or donor tissue around and sometimes through the raised collarbone.

The repairs work well, but there is still a failure rate due to tissue stretching or bone weakening. Several types of repairs have been developed, including plates with screws in the bone, bands of artificial material attached to bone-shaped metal restraints for dogs, and other combinations of artificial material. Unfortunately, many of them pull through the bones. We prefer the use of donor tissue to reproduce as closely as possible the normal anatomy of the damaged ligaments, supported by suture material and supplemented with Growth factor injections after surgery. AC Joint repairs are outpatient interventions that are carried out as part of a local regional block. The procedure uses natural tissues that ensure excellent AC joint stability. This, in our opinion, is the safest and strongest way to rebuild the AC joint with the lowest rate of complications. Potential complications can include loss of fixation or loss of stability, which most commonly occurs when a patient has a repeated fall during the early healing phase.

Having a great rehabilitation program that begins immediately after surgery is critical to a full recovery. On the first day after the operation, a soft tissue massage of the neck and surrounding muscles as well as a whole body conditioning program is initiated, with which the athlete can be brought back fitter, faster and stronger than before the injury. Stationary bike, core exercises, and shoulder blade stabilization exercises are used to begin cardiovascular training on the first day with the aim of making the patient feel more like an athlete in training than a patient in rehabilitation. Immediate repair and targeted rehab can ensure a quick return to full activity, typically three months after the repair. Significant AC joint injuries are another example of how conservative care should mean early repair rather than nonsurgical care if the critically torn tissues can be repaired.

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The views expressed above are the author’s own.