I. General

  1. Acromioclavicular joint dislocation or "Separation"

II. Mechanism

  1. Fall on an outstretched hand
  2. Direct trauma
    1. Top of Shoulder or
    2. Acromion with Shoulder adducted

III. Grading: AC joint dislocation (Rockwood Classification)

  1. Incomplete dislocation (Types I to II)
    1. Type I: Simple AC joint Contusion or strain
    2. Type II: AC joint ligament rupture
  2. Complete dislocation (Types III to V)
    1. Type III: Rupture of coracoclavicular ligaments
    2. Type IV: Joint posteriorly displaced (uncommon)
    3. Type V: Overlying muscle penetrated (uncommon)
    4. Type VI: Clavicle displaced behind biceps (rare)

IV. Symptoms

  1. Tenderness and swelling over AC joint
  2. Pain on lifting arm

V. Signs

  1. Outer clavicle elevated
    1. Deformity if Grade III or higher
  2. Provocative Maneuvers eliciting pain
    1. Downward traction on arm
    2. Shoulder Crossover Maneuver

VI. Differential Diagnosis

VII. Complications

  1. Clavicle Fracture (lateral third)
  2. Coracoid process Fracture

VIII. Radiology: Clavicle XRays

  1. Differentiate incomplete from complete AC Dislocation
  2. Weighted views are no longer indicated
    1. Diagnosis is clinical and XRay may be diagnostic with step-off seen
    2. Old protocol used XRay taken with 10 kg weights hanging from each arm
      1. Measured coracoid process to clavicle distance
      2. Discrepancy between sides suggested AC Dislocation

IX. Management

  1. Symptomatic relief
    1. Immobilize with sling for 3 days based on pain
    2. See RICE-M
    3. Analgesics as needed
      1. Clavicle tip often prominent, but usually painless
  2. Active range of motion of strengthening
    1. Begin as soon as possible
    2. See Shoulder Range of Motion Exercises
    3. See Shoulder Strengthening Exercises
  3. Surgery Indications
    1. Type 4 to 6 AC Dislocation
    2. Type 3 AC Dislocation if physically active

X. Management: Taping Technique (consider in Wilderness)

  1. Realignment
    1. Examiner 1 pushes down on clavicle
    2. Examiner 2 pushes up on upper arm from elbow
  2. Taping technique
    1. Start Tape from just medial and superior to nipple
      1. Extend tape over Shoulder and onto mid Scapula
      2. Repeat with overlapping strips moving laterally
    2. Secure above taping with tape over ends
    3. Start tape perpendicularly to above
      1. Run over top of Shoulder from medial to lateral

XI. References

  1. Wirth in Greene (2001) Musculoskeletal Care, p.115-7

Images: Related links to external sites (from Google)

Ontology: Dislocation of acromioclavicular joint (C0149820)

Concepts Injury or Poisoning (T037)
ICD10 S43.1
SnomedCT 263019000, 157259008, 269325002
English ACROMIOCLAVICULAR JOINT, DISLOCATION, AC DISLOCATION, ACROMIO CLAVICULAR JOINT DISLOCATION, Disloc acromioclav joint, dislocation of acromioclavicular joint (physical finding), dislocation of acromioclavicular joint, dislocation of AC joint, Dislocation of acromioclavicular joint, Dislocation of acromioclavicular joint (disorder), Acromioclavicular joint disloc, dislocation of the AC joint, Dislocation;AC joint
Spanish Dislocation of acromioclavicular joint, Acromioclavicular joint disloc, luxación de articulación acromioclavicular (trastorno), luxación de articulación acromioclavicular
German Luxation des Akromioklavikulargelenkes
Korean 봉우리빗장관절의 탈구
Dutch Luxatie van acromioclaviculair gewricht

Ontology: Sprain of acromioclavicular ligament (C0272870)

Concepts Injury or Poisoning (T037)
ICD9 840.0
ICD10 S43.5
SnomedCT 27182002, 209411006
English Acromioclavicular (joint) (ligament) sprain, Sprain of acromioclavicular joint or ligament, Sprn lig acromioclavic joint, Sprain acromioclavicular joint, Sprain of acromioclavicular joint AND/OR ligament, sprain of acromioclavicular joint (diagnosis), sprain of acromioclavicular ligament, sprained acromioclavicular joint, sprained acromioclavicular ligament, sprain of acromioclavicular ligament (diagnosis), sprain of acromioclavicular joint, Sprain acromioclavicular, acromioclavicular sprain, acromioclavicular sprains, Sprain of ligament of acromioclavicular joint, Sprain of acromioclavicular joint, Sprain of acromioclavicular ligament (disorder), Sprain of acromioclavicular ligament, Sprain of acromioclavicular joint AND/OR ligament (disorder), Sprain of ligament of acromioclavicular joint (disorder), Acromioclavicular joint sprain, Acromioclavicular ligament sprain, Acromioclavicular sprain
Dutch acromioclaviculair (gewricht) (ligament)-verstuiking
French Entorse du ligament de l'articulation acromio-claviculaire
German Akromioklavikulargelenk, -ligament, Verstauchung
Italian Distorsione acromioclavicolare (articolazione) (legamento)
Portuguese Entorse acromioclavicular (articulação) (ligamentos)
Spanish Esguince (articular) (ligamentoso) acromioclavicular, esguince del ligamento Y/O de la articulación acromioclavicular (trastorno), esguince del ligamento Y/O de la articulación acromioclavicular, esguince del ligamento acromioclavicular (trastorno), esguince del ligamento acromioclavicular, esguince del ligamento de la articulación acromioclavicular (trastorno), esguince del ligamento de la articulación acromioclavicular, estrema del ligamento o de la articulación acromioclavicular
Japanese ケンサカンセツジンタイネンザ, 肩鎖(関節)(靱帯)捻挫
Czech Podvrtnutí (vazu) akromioklavikulárního kloubu
Hungarian Acromioclavicularis (ízület) (szalag) rándulás

Ontology: Acromioclavicular separation (C2363930)

Concepts Injury or Poisoning (T037)
English Acromioclavicular separation
Spanish Separación acromioclavicular
Dutch acromioclaviculaire scheiding
Italian Separazione acromioclavicolare
German Luxation des Akromioklavikulargelenkes
French Séparation acromio-claviculaire
Portuguese Separação acromioclavicular
Czech Akromioklavikulární separace
Japanese 肩鎖関節離開, ケンサカンセツリカイ
Hungarian Acromioclavicularis szétválás