acromioclavicular blast

Schultereckgelenksprengung: Description

The Schultereckgelenk (Akromioklavikular- (AC) joint) connects together with the sternoclavicular joint trunk and arms. It is important for the position of the scapula while the arm is being moved. If you support yourself on the arm, the power is transferred to the trunk via the shoulder joint. The Schultereckgelenk is vertically supported by the coracoclavicular ligaments (coracoclavicular ligament) and horizontally by the capsule-enhancing ligaments (acromioclavicular and other ligaments). In a Schultereckgelenksprengung these stabilizing ligaments are injured, sometimes even completely demolished.

Depending on how severe the acting force was, there are three degrees of severity according to Tossy in the shoulder joint blasting:

• Tossy Classification I: The capsule is overstretched without the clavicle being displaced.
• Tossy Classification II: The joint capsule is torn together with the acromioclavicular ligaments.
• Tossy Classification III: The coracoclavicular ligaments are completely torn and the clavicle is displaced by more than one shaft width.

Furthermore, the shoulder articulation has the Rockwood classification, which distinguishes six types:

At the Type I The capsule of the Schultereckgelenk is overstretched and partially torn. The bones do not shift under load.

At the Type II If the joint capsule is torn, the coracoclavicular ligaments are stretched. When an X-ray load recording, the collarbone has stepped higher than the shoulder roof (Akromion).

In a Schultereckgelenksprengung of Type III In addition, the coracoclavicular ligaments are torn. The collarbone has stepped higher than the shoulder roof by a shaft width.

A Type IVInjury occurs when the collarbone is additionally unstable in the horizontal plane because the fascia (deltotrapezoid fascia) is partially torn. The attachment of the deltoid muscle to the collarbone is torn off, and the collarbone is pushed backwards.

In a Schultereckgelenksprengung of Type V The fascia (Deltotrapezoidfaszie) is completely torn, while the lateral end of the clavicle is massively upwards.

At the Type VI the lateral collarbone is hooked under the bony process of the scapula (coracoid process).

Schultereckgelenksprengung: symptoms

Ankle dysfunction is typically markedly painful and swollen. In addition, a bruise is often seen. The affected can no longer move the shoulder joint completely. Most of the lateral clavicle end is up, creating over the Schultereckgelenk a protrusion. The patients therefore often take a restraint. Typical of a Tossy-III shoulder joint blast is the so-called piano key phenomenon: like a piano key, the end of the collarbone, which is elevated, can be pushed down and then spring back up when released.

Schultereckgelenk blasting: causes and risk factors

The Schultereckgelenksprengung is usually a sports injury: It is usually caused by a fall on the applied arm, rarely on the outstretched arm or on the shoulder. This can happen during soccer or skiing.

Schultereckgelenksprengung: investigations and diagnosis

If shoulder joint is suspected you should consult a doctor for orthopedics and traumatology. He will first ask you about the accident and your medical history. Some questions could be:

• How did the accident happen exactly?
• Did you fall on the arm or the shoulder?
• Can you still move the shoulder or the arm?
• Do you have pain?
• Did you have any complaints like pain, restriction of movement or a previous dislocation?

This is followed by the physical examination. Sometimes, in a Schultereckgelenksprengung the collarbone moves upwards, which is then visible to the naked eye. If the doctor presses on the higher standing end of the collarbone (which is very painful for the patient) and pushes it back up when released (piano key phenomenon), this indicates a Tossy III injury.

For a slight shoulder articulation with the clavicle end not up, it will be checked if it can be moved horizontally. If you can move the side of the clavicle back and forth with two fingers in a horizontal plane, there is a Tossy II injury.

For further diagnostics X-rays are taken. Here, a so-called panoramic photograph is taken, in which both shoulder joints are taken up with a weight of 10 to 15 kilograms on the drooping arm. In the side comparison can be detected so that the outer end of the clavicle is dislocated.

Schultereckgelenksprengung: treatment

A mild shoulder joint fracture (Tossy I and II or Rockwood types I to III) can be treated conservatively. Here, the Schultereckgelenk is initially made quiet in the so-called Gilchristverband for about two weeks. For about one to two weeks, the patient receives pain medication. In addition, the shoulder area can be treated with cold. Subsequent physiotherapy can have a positive effect on the healing process. The shoulder should be moved but only for four to six weeks to the horizontal plane.

Schultereckgelenksprengung: surgery

Operation is eligible for Tossy III severity and Rockwood types IV through VI. The goal is to restore the joint so that the joint surfaces fit together again. There is the possibility to stabilize the Schultereckgelenk directly or indirectly. In both methods, the torn ligaments will be able to heal stable again. For stabilization, the tension belt, hook plate, Kirschner wires or dissolving plastic cords are used. The operation can be either open (incision incisally to the collarbone) or closed (via an articulation = arthroscopy).

Schultereckgelenksprengung: Disease course and prognosis

After conservative treatment, the prognosis is good for a Rockwood type I to III. In the case of Rockwood Type II injury, however, an incompletely dislocated shoulder joint can cause painful arthrosis. This may also be the case with type III injury, as the shoulder joint may partially outgrow with time after the scars have shrunk. Sometimes this needs to be corrected surgically.

In general, after a shoulder articulation, there is rarely any pain during movement or strain on the shoulder. Immediately after the accident, the collarbone is initially disturbing, as it is up. However, after four weeks you will not see this anymore.

Like any surgery, surgery for shoulder articulation can also cause complications. The fracture may be postponed even after surgery in rare cases. Furthermore, the pain can persist. The cosmetic result after operative care of one acromioclavicular blast may be unsatisfactory if excess scar tissue has formed.