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76 Cards in this Set
- Front
- Back
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what type of joint is the AC joint
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synovial
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what are the three components of the ACJ
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distal end of clavicle with acromion +articular disc
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what is the resting position of the AC joint
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arm by the side in the normal resting position
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what is the close packed position of the ACJoint
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shoulder abducted to 90
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what indicates capsular patterns for the AC joint
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pain at the extreme range of motion
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what is the kinesiological elements of the ACJ
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convex clavicle on concave acromion
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what is the "motion" that occurs at the AC joint
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mostly spin along the long axis of the clavicle during flexion and abduction of the arm
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what is a "seperated shoulder"
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a sprain of the AC joint
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what is the most common injury to the AC joint
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a sprain - aka a seperated shoulder
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describe the mechanism of injury of a seperated shoulder
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direct blow to the tip of the shoulder pushing the acromion process downward--> scapula driven downward while clavicle is blocked against 1st rib
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what is a type I injury of the AC joint
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first degree sprain
1) stretch (partial tear of the acromioclavicular ligament 2) coracoclavicular ligaments are intact 3) deltoid and trap muscles are intact |
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what are the S and S of a first degree sprain of the AC joint
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1) point tenderness to palpation of the ACJ
2) local swelling 3) pain at end-range of shoulder horizontal adduction- little pain and disability with other movement of the shoulder 4) no deformity/displacement of the distal end of the clavicle |
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what differentiates ACJ sprain from rotator cuff pain
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location- pain will be in the subactomial space 3/4" away from acromion
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what is the treatment for a frist degree ACJ sprain
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treat as an acute sprain
goal: 1) decrease pain and inflammation 2) protection/stabilization Methods: 1) icec, modalities, medications 2) sling, taping, hand in pocket to support weight of arm (typically not necessary) 3) AROM exercices are allowed immediately within pain tolerance |
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when can a patient with a first degree sprain of the ACJ begin ROM exercises
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AROM exercises are allowed IMMEDIATELY within the pain tolerance
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what is the "taping" that can be done with an AC joint seperation injury
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anchor shoulder with the arm in abduction to create tension when neutral
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what is a second degree sprain of the ACJ
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1) rupture of the supportiong superior and inferior acromioclavicular ligaments
2) stretch (partial tear) of the coracoclavicular ligaments 3) minor detachment of the deltoid and trapezius muscle |
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what causes a step deformity
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a stretch (partial tear) of the coracoclavicular ligaments
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what ligament is NOT involved with a shoudler seperation
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coracoacromial ligament
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what are the S and S of for a second degree sprain of ACJ
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1) definite displacement and prominence of the distal end of the clavicle
2) decreasesd shoulder ROM 3) pain with full shoulder abduction and expecially horizontal adduction 4) laxity of the ACJ (test for anteroposterior and sup/inf mobility) 5) local swelling and point tenderness to palpation of the ACJ 6) positive stress AP view radiographs |
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what is used to confirm the diagnosis of a second degree ACJ sprain
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AP radiographs of both shoulders taken with patient standing with weight strapped to wrist (not held in hands)
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what is the treatment for a second degree sprain to the ACJ
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symptomatic approach:
1) initial tx is same as 1st degree (meds, ice, modalities) 2) typically pt. needs sling, taping, hand in pocket to support weight of arm for a week or two (based on pain) 3) allow/protect for 5-6 weeks for fibrous healing to occur 4) AROM exercises are allowed immediately within pain tolerance 5) An extended period of time is necessary for rehavilitation of range of motion, strength and function alternative approach: Kenny-howard sling for 4-6t weeks that maintains ACJ in position. method rarely used because of difficulty with compliance |
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how common is it for residual symptoms to be present in ACJ injuries
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with symptom approach = 60%
with alternative approach only 25% |
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what injury is a kenny howard sling used for and how long is it worn
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ACJ second degree sprain--- 4-6 weeks
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what is a third degree AC sprain
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1) ACJ seperation
2) rupture of the acromioclavicular lig 3) rupture of the coracoclavicular lig 4) deltoid and trapezius muscles partially detached from distal end of clavicle |
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what are the S and S of a 3 degree sprain of the AC joint
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1) gross deformity of the shoulder with distal end of the clavicle being prominent
2) severe pain 3) loss of movement 4) laxity of the joint 5) swelling |
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what is the treatment for a third degree sprain of AC joint
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disagreement exists on best option: non-treatment, conservative, or surgical
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what is the decision for type of tx based on
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age, hand dominance, and activities.....
younger, dominant side, and more active are more likely to have surgery |
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what is the non-treatment (symptomatic) choice for treating a third degree sprain of the AC joint
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1) short period of immobilization in a sling while the initial pain and inflammation subsides
2) progressive rehab as the pain subsides |
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what are the (+) and (-) to a non-treatment (symptomatic) approach to tx the 3rd degree AC joint sprain
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(-) leads to permanent deformity, possible residual pain and loss of function
(+) minimal time and expense is needed for rehabilitation |
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what is the conservative treatment for 3rd degree ACJ sprain
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1) reduction of the deformity with prolonged immobilization using a kenny-howard sling (minimum of 6 weeks, 24 hours/day)
2) focus on exercising wrist, elbow, and hand during immobilization |
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(+) and (-) to conservative tx for 3rd degree ACJ sprain
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(-)immobilization is lengthy and often painful
(+) best option to avoid deformity and surgery..... but deformity may still be present after the immobilization is discontinued |
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explain the surgical repair done for a 3rd degree ACJ sprain
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some repair to ligamentous structures and a choice of AC fixation followed by a progressive rehab program
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what are the 3 types of AC fixation that could be used during surgery
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1) transfixing pin (pin through acromion and distal clavicle)
2) screw through clavicle to coracoid process 3) use of a wire attaching clavical to coracoid process |
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what is a bosworth screw
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used to screw the clavicle to the coracoid process
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what are the S and S of a 3 degree sprain of the AC joint
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1) gross deformity of the shoulder with distal end of the clavicle being prominent
2) severe pain 3) loss of movement 4) laxity of the joint 5) swelling |
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what is the treatment for a third degree sprain of AC joint
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disagreement exists on best option: non-treatment, conservative, or surgical
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what is the decision for type of tx based on
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age, hand dominance, and activities.....
younger, dominant side, and more active are more likely to have surgery |
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what is the non-treatment (symptomatic) choice for treating a third degree sprain of the AC joint
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1) short period of immobilization in a sling while the initial pain and inflammation subsides
2) progressive rehab as the pain subsides |
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what are the (+) and (-) to a non-treatment (symptomatic) approach to tx the 3rd degree AC joint sprain
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(-) leads to permanent deformity, possible residual pain and loss of function
(+) minimal time and expense is needed for rehabilitation |
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what is the conservative treatment for 3rd degree ACJ sprain
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1) reduction of the deformity with prolonged immobilization using a kenny-howard sling (minimum of 6 weeks, 24 hours/day)
2) focus on exercising wrist, elbow, and hand during immobilization |
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(+) and (-) to conservative tx for 3rd degree ACJ sprain
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(-)immobilization is lengthy and often painful
(+) best option to avoid deformity and surgery..... but deformity may still be present after the immobilization is discontinued |
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explain the surgical repair done for a 3rd degree ACJ sprain
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some repair to ligamentous structures and a choice of AC fixation followed by a progressive rehab program
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what are the 3 types of AC fixation that could be used during surgery
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1) transfixing pin (pin through acromion and distal clavicle)
2) screw through clavicle to coracoid process 3) use of a wire attaching clavical to coracoid process |
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what is a bosworth screw
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used to screw the clavicle to the coracoid process
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what are the S and S of a 3 degree sprain of the AC joint
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1) gross deformity of the shoulder with distal end of the clavicle being prominent
2) severe pain 3) loss of movement 4) laxity of the joint 5) swelling |
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what is the treatment for a third degree sprain of AC joint
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disagreement exists on best option: non-treatment, conservative, or surgical
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what is the decision for type of tx based on
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age, hand dominance, and activities.....
younger, dominant side, and more active are more likely to have surgery |
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what is the non-treatment (symptomatic) choice for treating a third degree sprain of the AC joint
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1) short period of immobilization in a sling while the initial pain and inflammation subsides
2) progressive rehab as the pain subsides |
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what are the (+) and (-) to a non-treatment (symptomatic) approach to tx the 3rd degree AC joint sprain
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(-) leads to permanent deformity, possible residual pain and loss of function
(+) minimal time and expense is needed for rehabilitation |
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what is the conservative treatment for 3rd degree ACJ sprain
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1) reduction of the deformity with prolonged immobilization using a kenny-howard sling (minimum of 6 weeks, 24 hours/day)
2) focus on exercising wrist, elbow, and hand during immobilization |
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(+) and (-) to conservative tx for 3rd degree ACJ sprain
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(-)immobilization is lengthy and often painful
(+) best option to avoid deformity and surgery..... but deformity may still be present after the immobilization is discontinued |
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explain the surgical repair done for a 3rd degree ACJ sprain
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some repair to ligamentous structures and a choice of AC fixation followed by a progressive rehab program
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what are the 3 types of AC fixation that could be used during surgery
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1) transfixing pin (pin through acromion and distal clavicle)
2) screw through clavicle to coracoid process 3) use of a wire attaching clavical to coracoid process |
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what is a bosworth screw
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used to screw the clavicle to the coracoid process
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why is the use of a pin not a common option for ACJ fixation
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it could break/migrate, etc
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what is the caution with wiring the clavicle to the coracoid process
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can get avascular changes
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what is the preferred technique for ACJ fixation
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using wire to attach the clavicle to the coracoid process
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when are ROM exercises initiated when a surgical repair is done for a third degree AC sprain
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as soon as pain subsides
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what ROM exercises should be done post surgical repair of a 3rd degree AC sprain
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pendulum and isometric exercises initially shoulder abduction and flexion limited to 90 degrees for 3-4 weeks
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what is a type 4 sprain of the AC joint
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1) rupture of acromioclavicular and coracoclavicular ligaments
2) posteiror displacement of distal end of clavicle through traps 3) deltoid and trapezius muscles are detached from distal end of clavicle |
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what are the S and S of a type 4 injury to the AC joint
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1) gross deformity
2) distal end of the clavicle is posterior to the acromioni 3) severe pain 4) loss of movement of the shoulder |
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what is the tx for a type 4 injury to the AC joint
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abnormal position of the clavicle may be difficult to reduce because it is trapped in the trapezius
after it is reduced it is a surgical treatment |
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what is a type 5 injury to the AC joint
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1) rupture of the acromioclavicular and coracoclavicular ligaments
2) complete rupture of the deltoid and trapezius musculature over the distal half or 2/3 of clavicle |
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what are hte S and S of a type 5 injury to the AC joint
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1) gross deformity
2) distal end of clavicle being covered only by skin and subcutaneous tissue |
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what is the treatment for a type 5 injury to the AC joint
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surgery and rehab like type 3
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what is a type 6 injury to the AC joint
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1) rupture of Acromioclavicular and coracoclavicular ligaments
2) disruption of SC joint (this injury requires EXTREME downward force to the superior aspect of the distal end of the clavicle with the arm in abduction and shoulder retraction) |
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what are the S and S of a type 6 injury to the AC joint
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unlike the other types, the distal end of the clavicle is displaced inferiorly
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what is the tx for a type 6 injury to the AC joint
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1) reduction
2) surgery and rehabilitation |
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what is ACJ degenerative arthritis
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arthritic changes occuring at the ACJ
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what are the S and S of ACJ degenerative arthritis
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1) tenderness to palpation of the joint line
2) (+) compression (shear) test 3) pain with full abduction 4) pain with horizontal adduction (reaching across the chest) |
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what is the conservative treatment for ACJ degenerative arthritis
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1) joint mobilization techniques
2) postural correction (a forward shoulder position increases pressure on the joint) 3) antiinflammatory 4) modalities aimed at decreasing the inflammation and pain |
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what is the surgical treatment for ACJ degenerative arthritis and when is surgery done
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done if conservative tx fails
1) arthroscopic surgical debridement of the joint 2) rermoval of the intraarticular disc 3) removal of the distal end of the clavicle |
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what is the screen test for ACJoint
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horizontal adduction: if pain free joint is likely okay.... be sure of location of pain, ACjoint vs. rotator cuff impingement
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what tests should be done during an ACJ evaluation
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palpation for pain, compression/shear test, joint play assessment (assess for pain and mobility)
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when should ACJ evaluations be done
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with any shoulder assessment even though injury is common and typically easy to determine
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