Separated shoulder

The acromioclavicular dislocation (also acromioclavicular blowing, AC joint blasting, ACG - blasting or AC blasting) is a traumatic external influences (eg fall on the shoulder) caused complete or incomplete disruption of the acromioclavicular ( coincidence of clavicle and Schultergräte forms the tip or the roof of the shoulder; ACG = Acromioclaviculargelenk ).

Classification

After JD Tossy the ACG lesion is divided into three grades depending on the extent of injury:

  • Tossy I = small tears of the ligamentous structures (only conservative treatment is necessary )
  • Tossy II = more tears to partial ruptures of the band structures ( surgical treatment option, but rarely )
  • Tossy III = Komplettruptur the entire shoulder stabilizing ligamentous structures ( surgical treatment may be recommended in younger patients, but also conservative treatment is possible).

New and more accurate classification by Rockwood

  • Rockwood I: strain of Kapsel-/Bandapparates. No acromioclavicular instability (corresponding Tossy I).
  • Rockwood II: Teilzerreißung of Kapsel-/Bandapparates (rupture of akromioklavikularen bands) with partial dislocation of the acromioclavicular joint (equivalent Tossy II).
  • Rockwood III: Rupture of the complete Kapsel-/Bandapparates (rupture of akromioklavikularen bands and the bands korakoklavikularen ) with complete dislocation of the acromioclavicular joint in the vertical plane by cephalad so-called acromioclavicular blast (equivalent Tossy III).
  • Rockwood IV: the lateral end of the clavicle dislocated in the horizontal plane. It can get caught in the trapezius muscle.
  • Rockwood V: Extreme clavicle high level with extensive replacement of muscle attachments at the lateral end of the clavicle.
  • Rockwood VI: Sprain of the lateral clavicle end towards the feet under the coracoid.

Diagnostics

For a complete rupture ( Tossy 3) and indicated even with larger partial ruptures can be triggered on physical examination the most painful " piano keys " phenomenon: the anomalous upward outer end of the clavicle can be pressed by the investigator as a piano button down springs but the easing the pressure immediately back up. The extent of the piano keys phenomenon is an indirect indication of the extent of the ligament injury. In the X-ray diagnostic imaging of both shoulders are made for comparison in cases of doubt. This can be done as a panoramic shot of the entire shoulder girdle. Here is the study with weights ( 5 to 10 kg) on the wrists sensitive than shooting without.

Therapy

Basically, II no surgical therapy indicated for Tossy I &, but the conservative supply by Gilchristverband or Desault Association together with physiotherapy and analgesia. Tossy III can be operated in younger patients (<35 years). For additional injuries or when conventional therapy is not indicated, are available depending on the severity of the injury multiple operation systems:

  • Kirschner wire
  • Wire loop ( cerclage )
  • Hook plate
  • Bosworth screw
  • TightRope system ( minimally invasive surgical technique )
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