One of the more unusual cases I saw earlier this year which I would like to share is of Acromio-clavicular joint (ACJ ) dislocation. I saw this 61 year old male who fell off his scooter 9 months prior and had a Grade III ACJ dislocation. He had full range of motion of his shoulder joint but had discomfort when he did his daily exercise’s. He was a very fit gentleman for his age.
We classify these injuries as a Grade I- VI dislocation. We also further classify them into acute (less than 3 weeks post injury) and a chronic injury (more than 3 weeks post injury.)
Treatment
A Grade I and II is treated conservatively with analgesia and a cortisone injection in the AC-joint. The treatment of a Grade III dislocation remains controversial. There are some guidelines to guide us to when to be more aggressive and do surgery and when not. These are:
1) manual labourer
2) dominant hand
3) overhead athlete
4) scapula-thoracic dysfunction
5) neurological symptoms
Currently the feeling is to treat a Grade III conservative for 3 weeks and see if the person cope or not. If they don’t cope, they will need an ACJ reconstruction. If however they fall into one of the above categories, I would suggest surgery. The reason for this approach is to give the patient’s own tissue the chance to heal. The problem with this is that the outcome of the treatment of a chronic dislocation is in my opinion is not always a good as an acute injury. For my patient I did an Acromioclavicular joint reconstruction with an artificial ligament and a coraco- acromioligament transfer. The outcome was good considering it being a chronic injury with a completely reduced joint 3 months post op and no pain with increased strength.
