Mississauga Chiropractor Presents: AC Sprains

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Here’s another blog from a Mississauga Chiropractor…

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Acromioclavicular (AC) Sprains are injuries to the capsule and or extra-capsular ligaments that support the acromioclavicular joint

 

Grades of Severity:

 

Grade

Description

1

  •   Injury is just at the AC capsule
  •   Localized pain, tenderness & swelling to   AC
  •   Minimal trapezius & levator spasms
  •   No visible displacement
  •   X-ray: -ve à   possible slight gapping with 10 lbs weight (2-4 mm joint space

2

  •   Injury to AC capsule & coracoclavicular   ligaments
  •   Pain & tenderness to AC &   subclavicular region
  •   More swelling/occasional brusing
  •   Marked trapezius & levator spasms
  •   Visible clavicle elevation (less than grade 3)
  •   X-ray: +ve à   superior displacement / elevation / separation
  •   < ½ thickness of distal clavicle (4-5 mm   joint space)

3

  •   Extensive AC joint & coracoclavicular   ligament involvement
  •   Severe AC & subclavicular pain &   tenderness
  •   More swelling / bruising / visible   displacement

 

Possible Causes:  Trauma

a)      Auto Accidents:  Shoulder is thrusted against a door or the seat belt causes pressure on the clavicle

 

b)      Contact Sports:  Football, hockey, wrestling, weight lifting (bench press/military press)  à Blow to the superolateral shoulder is the most common mechanism of injury

 

c)      Fall on superolateral shoulder or on outstretched hand

 

d)      Heavy lifting or pulling (i.e. luggage)

 

History:

a)      A history of trauma that leads to pain & swelling; pain may be vague & poorly localized (neck, upper back & shoulder) due to trapezius, parascapular & neck muscle spasms

 

b)      Possible antalgic posture

  1. Shoulder is lower overall; involved scapula is inferior (grade 2-3) when viewed from behind
  2. Prominent distal clavicle – accentuated by holding 10-20 lb weight (grade 2-3) when viewed from front; local swelling & redness
  3. Antalgic posture; patient may support arm (holding the elbow) to protect in grade 2-3

 

Management:

a)      Acute:

  1. Reduction – press up on the elbow and down on the clavicle
  2. Strap/brace – universal sling works best to hold (elastic wrap, taping or AC sling)
  3. ICE, REST (no elevation)
  4. Electrotherapy to reduce pain, spasms
  5. Sleep with injured side up

 

b)      Post-acute: (marked improvement by 2 weeks)

  1. Electrotherapy & massage the parascapular muscles; sling for 2-4 weeks (reduce the use of sling as soon as possible)

 

Prognosis:

a)      Grade 1: asymptomatic in approximately 2 weeks (some residual soreness with repetitive use may persist up to 6 weeks)

b)      Grade 2-3: asymptomatic in approximately 6-8 weeks – Step defect may be evident

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