Clinics in sports medicine
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Injuries and conditions that affect the AC joint are common. Low-grade separations, degenerative conditions, and osteolysis of the distal clavicle are frequently dealt with by the treating physician. Proper assessment requires a thorough history, examination, and radiologic work-up. ⋯ Complications related to this procedure are relatively infrequent and include infection, residual pain, lack of adequate bone resection, and instability, particularly in patients with previous grade 1 and 2 separations. Less commonly noted is the symptomatic development of heterotopic bone. To the accomplished arthroscopic shoulder surgeon, arthroscopic resection of the symptomatic AC joint gives excellent clinical results that allow a compromised athlete a relatively quick return to desired sport activities.
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Although common, AC joint injuries and their treatments are not benign. The injury itself and both nonsurgical and surgical treatments may result in complications yielding persistent pain, deformity, or dysfunction. ⋯ As such, the associated complications may be more serious. Familiarity with the potential complications of these injuries can help the treating physician to develop strategies to minimize their incidence and sequelae.
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Review
Decision making: operative versus nonoperative treatment of acromioclavicular joint injuries.
The classification system devised by Allman and Tossy, and revised by Rockwood, defines the extent of injury to the AC joint and helps to guide management of AC joint injuries [1,4,6]. In general, type I and II injuries may be treated nonoperatively with a sling, mainly for comfort, for a short period of time. Once this is removed, strength and motion are regained with rehabilitation. ⋯ There is no correlation between reduction and improvement in pain, strength, or motion, however. These patients usually are able to return to full sport with no deficits if rehabilitation is emphasized. For those patients who fail conservative management, a multitude of surgical techniques, such as the modified Weaver-Dunn procedure, exist to reconstruct the AC joint.
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Acromioclavicular injuries are common and most often can be accurately diagnosed using history, physical examination, and routine radiography. Sternoclavicular subluxations and dislocations may also be accurately characterized with only history, physical examination, and routine radiography (i.e., serendipity view). ⋯ When this is suspected, angiography or CT angiography is indicated. Physeal injuries should be suspected at either end of the clavicle in adolescent patients.