Shoulder Impingement

Shoulder Information

Acromio-clavicular joint injury Types

The extent of injury to the ligaments of the AC Jt often requires specially performed "stress" x-rays

Type I	Type II	Type III, IV V and VI

Intra-articular damage of the acromio-clavicular joint alone without ligamentous instability either of the joint capsule or of the coraco-clavicular ligaments	Dislocation of the acromio-clavicular joint and disruption of its capsule and ligaments without disruption of the coraco-clavicular ligaments	Acromio-clavicular separation with disruption of the coraco-clavicular ligaments as well as the AC ligaments leaving the clavicle grossly unstable - coracoclavicular interspace 25- 100% greater than normal side
treated initially *non-operatively*. Supportive sling for 3 - 4 weeks, mobilisation of the shoulder Late resection of the distal part of the clavicle ( = Mumford procedure) reliably produces significant clinical improvement if patients develop problems (rarely).		*surgical repair* may need to be considered.

Classification

•Allman (extended by Rockwood)

•I AC ligament sprained

–no increase in coraco-clavicular interspace

•II AC ligament ruptured + CC ligament sprained

–<25% increase

•III AC + CC ligaments ruptured

–25 - 100% increase

•IV as III + clavicle posterior into trapezius

•V as III + gross disparity (muscles stripped)

–100 - 300% increase

•VI subcoracoid or subacromial dislocations

The 1972 approach may need to be reconsidered:

Weaver and Dunn operation equally effective for both early and late cases therefore no indication to operate in the acute stage except in selected cases, patients who do heavy work and those whose daily work or recreational activities requires that the shoulder be held in an abducted position
ref: Weaver and Dunn " Treatment of AC injuries, especially complete AC separation"
JBJS 54A: 1187-1197, 1972

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