Acromioclavicular Joint Injury (Shoulder Separation)
The acromioclavicular joint is formed by the cap of the shoulder and the collar bone (acromion and clavicle, respectively). These two are joined by three firm ligaments. The outer end of clavicle farthest from the body is held in alignment with the acromion by the acromioclavicular ligaments and the coracoclavicular ligaments. The acromioclavicular joint generally is sturdy, however, the location where it is situated makes it exposed and vulnerable to trauma and injury. Thus, Acromioclavicular Joint Injury, also known as shoulder separation. This can be precipitated by injuries and accidents such as falls, or hyperextension.
Types
Acromioclavicular injury can be classified into six types. This classification is dependent on the xtent of injury and the number of ligaments affected. Classifying the type of Acromioclavicular injury may spring from the date obtained from physical assessment and results of various laboratories such as X-rays.
Type I injuries
- This type involves a sprain or partial tear of acromio clavicular ligaments with no injury to the coracoclavicular ligaments. This leads to a painful and tender acromio clavicular joint that is accompanied by mild swelling. This type can be treated and healed in a few days to weeks.
Type II injuries
- This type involves a complete tear of the acromio clavicular ligaments and a sprain or incomplete tear of the coracoclavicular ligaments. This leads to a tender acromio clavicular joint, and accompanied by a significant swelling.
Type III injuries
- This involves a complete tear of the acromio clavicular and coracoclavicular ligaments. The acromio clavicular joint appears abnormal, even though swelling may obscure the extent of injury. There is a significant tenderness of the coracoclavicular ligaments, this tenderness distinguishes type III from type II injuries.
Type IV, V, VI injuries
- These types of injury is the most severe. Management and treatment odf such type will warrant surgery.
Management
Generally, treatment and management of acromio clavicular injury involves pain management therapy. However, the specific treatment depends on the type and classification of the injury. The severity therefore suggests what therapeutic regimen is indicated to a specific patient.
Type I – Injuries under Type I are treated with rest, ice application and arm sling support. Ice application can be done 15 minutes every four to six hours as necessary. Patient should avoid lifting, leaning on the elbows, overhead reaching, reaching across the chest and sleeping directly on the shoulder. Range-of-motion (ROM) exercises are suggested to maintain mobility and flexibility.
Type II – Injuries under Type II are treated with rest, ice application, arm sling support and pain medications. Ice application can be done 15 minutes every four to six hours as necessary. Patient should avoid lifting, leaning on the elbows, overhead reaching, reaching across the chest and sleeping directly on the shoulder. Range-of-motion (ROM) exercises and strengthening exercises are suggested to maintain mobility, flexibility and muscle strength respectively.
Type III – Injuries under Type III are treated with rest, ice application, arm sling support and pain medications. Ice application can be done 15 minutes every four to six hours as necessary. Patient should avoid lifting, leaning on the elbows, overhead reaching, reaching across the chest and sleeping directly on the shoulder. Range-of-motion (ROM) exercises and strengthening exercises are suggested to maintain mobility, flexibility and muscle strength respectively. Type III patients may now return to normal activities after the sixth or seventh week after injury.
Type IV, V, VI – this type is sever and a little complicated, so it is advise that patients should see a physician because they may warrant surgical repair and management.
Byron Webb Romero, RN, MSN
Finished BSN at Lyceum of the Philippines University, and Master of Science in Nursing Major in Adult Health Nursing at the University of the East Ramon Magsaysay Memorial Medical Center. Currently working at Manila Doctors College of Nursing as a Team Leader for Level I and II, Lecturer for Professional Nursing Subjects, and also a Clinical Instructor.
