IC306-2021: Case-based Approach to the Management of AC Joint Injuries - An International Perspective-Case-based Approach to the Management of AC Joint Injuries

Video Transcription

Video Summary

In this video, the presenter discusses AC joint injuries and their management. They start with a case presentation of a 59-year-old male who fell and injured his left shoulder. The initial plan was non-operative treatment with a steroid injection and physical therapy, which provided some relief. However, the patient later returned with pain and limited range of motion. An MRI revealed a tear of the AC ligaments, but the CC ligaments and rotator cuff were intact, leading to continued non-operative management.<br /><br />The presenter then discusses the anatomy of the AC joint, including the AC and CC ligaments, and their role in stabilizing the joint. They also mention a study that evaluated the biomechanics of the AC joint and found that cutting the AC capsule significantly reduced stability.<br /><br />The Rockwood classification system for AC joint injuries is then explained, ranging from sprains to complete dislocations. Associated shoulder pathologies are also discussed, with about 15-18% of AC joint injuries having accompanying injuries such as slap lesions or rotator cuff tears.<br /><br />Diagnosis involves physical examination and imaging, such as x-rays, Zenck views, and MRI. The presenter emphasizes the importance of evaluating for horizontal instability.<br /><br />Treatment varies depending on the type of injury, with non-operative management recommended for types 1 and 2 injuries. Surgical management may be considered for type 3 injuries if there are significant deformities, persistent pain, or higher functional demand. Scapular dyskinesia can occur as a consequence of non-operative management, leading to altered scapulothoracic rhythm.<br /><br />In conclusion, the AC joint plays a critical role in shoulder movement, and injuries can occur due to direct trauma. Proper classification and management are important for optimal outcomes.

Asset Caption

Mary Mulcahey, MD

Keywords

AC joint injuries

management

non-operative treatment

Rockwood classification system

diagnosis