Acromioclavicular joint separation is a very common shoulder injury, particularly amongst people who have been involved in a sporting accident. Sports such as cycling, skiing, football and snowboarding have a high rate of ACJ separation, as there is a high risk for falls which can impact the point of the shoulder. The severity of the injury can be classified at three different levels: mild, moderate or severe. Mild separations are usually characterised by the stretching of ligaments, and this can also apply in moderate cases. Severe injuries are characterised by the rupture of ligaments which hold down the collar bone or clavicle, and this makes the collar bone have a more prominent appearance.
Severe injuries are also known as Grade 3 injuries. The visual sign of these injuries is the tearing of the Coraco Clavicular ligaments as well as the Acromioclavicular capsule. Visually, this results in a bump or abnormal looking growth on the top of the shoulder.
It is not possible for these ligaments to heal completely. An accurate assessment of the severity of the injury can be ascertained using x-rays combined with a clinical examination. In some cases, it may be necessary to have the patient hold a weight during the x-ray.
Successful treatment is possible for mild or moderate separations (Grade 1 or 2), which should be kept in a sling for a couple of weeks. Physiotherapy and gradual mobilisation should then commence for an appropriate period as recommended by your specialist. Most people respond well to this course of treatment and will not require surgery.
Severe injuries (grade 3) have two options for treatment: nonoperatively or operatively.
Patients who opt for non-operative treatment will need to immobilise the joint with a sling, which should remain in use for at least two weeks. Physiotherapy should then commence, following the full course recommended by your specialist. The bump at the top of the shoulder will always remain visible, and in some cases the acromioclavicular joint can also develop arthritis – even years after the injury has occurred. If this does occur, a small operation will address the issue. Some patients suffering from this injury may experience ongoing pain. People who regularly engage in heavy overhead work or throwing may also experience permanent weakness.
Surgery requires a small incision to be made across the top of the shoulder. Because the end of the collar bone is permanently damaged, it will be removed. An artificial ligament will then replace the torn Coraco Clavicular Ligament. The artificial ligament is made from Dacron, a durable synthetic material. It may also be possible to make it using a tendon located in another area of the body.
The rate of successful surgery improves when carried out within 3 weeks of sustaining the injury. It is possible to have surgery done at a later stage, but due to the nature of the injury and the operation involved, it may not be as successful. People exhibiting signs of chronic injury and those who have been living with it long-term may require an entirely different operation. This is known as a Coraco Clavicular Fusion, and it will require a bone grafting procedure to be carried out.
It is important that contact/throwing athletes and people who are involved in heavy manual and overhead work have surgery done as soon as possible after they have been injured.
For most other patients, a non-operative approach may be sufficient. It is important that you realise there is a small element of risk, because not everyone responds favourably to non-operative treatment. Therefore surgery may be required later, and the success rate may not be as high as it would have been if the operation were done immediately after the injury occurred.