Acromioclavicular joint injuries

Injuries and disorders of the distal clavicle and AC joint are common among the young active population and are routinely encountered by practitioners involved in the care of athletes and the musculoskeletal system. Most distal clavicle fractures can be managed non-operatively with a sling. Despite evidence that suggests that patients who develop nonunions may be relatively asymptomatic, most authors recommend that unstable type II distal clavicle fractures be treated with internal fixation. Osteoarthritis is a common radiographic finding that is often asymptomatic and does not require treatment. For patients who have focal tenderness over the AC joint and increased pain with adduction of the ipsilateral arm, an AC joint injection and modification of activities can provide significant relief. Osteolysis presents with similar complaints but is relatively rarer. This process, which may be related to repetitive microtrauma, tends to occur in young adults who are involved in extensive upper body-strengthening exercises. Nonoperative management may provide temporary respite but because of the frequent desire to continue with the exacerbating activities may be ineffective in the long-term. The management of AC joint instability has undergone significant evolution. Although consensus opinion supports nonoperative management, with a simple sling, for type I and II sprains and surgery for type IV, V, and VI sprains, the treatment of type III sprains is more controversial. Over the past 10 to 15 years, there has been a trend toward nonoperative management for type III sprains, but this is not yet accepted by all. A group of patients with type III sprains, who in general are athletes and manual laborers, seem to be at increased risk of experiencing significant long-term problems. In this select group, earlier surgical intervention may be appropriate.