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The coracoacromial ligament is a strong triangular band that connects the coracoid process to the acromion and also provides vertical stability. Branches from the suprascapular artery, which originates from the subclavian artery, and thoracoacromial arteries, which originates from the axillary artery, form the 2 main blood vessels that provide vascular supply to the acromioclavicular joint. The AC joint is innervated by articular branches of the suprascapular, axillary, and lateral pectoral nerves.
These nerves arise from the brachial plexus. Cutaneous innervation to the AC joint is through the sensory branch of the suprascapular nerve.
This branch runs superiorly to the supraspinatus muscle towards the AC joint. However, pain arising from the AC joint may be referred to the neck, trapezius, lateral deltoids, and shoulder. Injuries to the AC joint are common. They can present as sprains or dislocations. However, sprains are more common. The most common etiology is direct trauma to the AC joint or lateral trauma providing an axial load on the joint space.
This can occur from motor vehicle accidents, sports or accidental trauma. Falling on the outstretched hand or elbow can also cause AC joint injuries. They will describe pain over the joint, possibly radiating to the shoulder or neck and made worse with movement or use of the arm.
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On exam, the provider may observe swelling, bruising, or deformity. There may be tenderness to palpation over the area. There may be limited active or passive range of motion of the shoulder or neck.
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The examiner should assess for anterior-posterior or superior-inferior mobility and laxity. In dislocations, the deformities may be obvious. It is important to evaluate the entire clavicle and shoulder for additional injuries in addition to performing a full neurovascular examination. A special test may assist in the evaluation of a suspected AC joint injury. Pain with any of these test may suggest AC pathology. The adduction or cross-arm test has the patient either actively or passively adduct their arm across the body in the axial plane.
Pain at the AC joint is a positive test, and it has the greatest sensitivity for AC joint pathology. In performing the shear test, the examiner applies an external force to the AC joint by simultaneously pushing the scapula from a posterior direction and the clavicle from an anterior direction. In the one-handed shear test, also known as Paxinos test, the examiners place their thumb on the posterior acromion and fingers on the mid-clavicle. The examiner then tries to squeeze the thumb and fingers together. Radiographic evaluation of the acromioclavicular joint is standard for suspected AC-joint injury or undifferentiated shoulder pain in the setting of trauma.
Standard AP, lateral, and axillary radiographs should be obtained.
If the diagnosis is uncertain, the Zanca view is the most accurate view for examining the AC joint. This is an antero-posterior view with the beam directed at the AC joint with 10 degrees of cephalic tilt. In grade 1 AC joint sprain, which is most common, radiographs will be normal. Disruption of the joint will be seen in grade 2 through 6.
Dislocations are staged according to the Rockwood classification of acromioclavicular and coracoclavicular joint injuries. Grade I and II sprains are self-limited and are managed with conservative therapy including a brief period of rest, sling, ice, anti-inflammatory medications, physical therapy, and a graded return to activity.
Treatment for grade III dislocations is controversial and is determined based on the occupation of the patient, their goals, and the consulting orthopedic surgeon. Grade IV to VI are rare, but require surgical correction due to the risk of comorbid injuries. Surgically managed injuries have a longer recovery and higher risk of complications. Incidence of AC joint osteoarthritis increases with age.
It can be through overuse, chronic degeneration, or through prior trauma secondary osteoarthritis. This leads to narrowing of the articular disc and degeneration of the cartilage. Osteoarthritis may lead to osteophytic lesions and subacromial impingement and compression of nearby structures.
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To access free multiple choice questions on this topic, click here. Illustration of acromioclavicular joint and it's associated ligaments including acromioclavicular ligament, coracoclavicular ligament and coracoacromial ligament. Contributed by Gray, Henry. Anatomy of the Human Body.
Philadelphia and New York: Lea and more This book is distributed under the terms of the Creative Commons Attribution 4. Turn recording back on. National Center for Biotechnology Information , U. StatPearls [Internet]. Search term. Affiliations 1 Ochsner Clinical School. It is natural and coincidental when the body is affected the mind is affected when mind is affected the body is affected. So, we should follow the anatomic therapy to maintain the body and mind healthy. Healer Baskar has been contributing the anatomic therapy as three days, five days and one-day camp.
Let us follow the anatomic therapy to live life long happily, peacefully, healthy. Language English English. Baby Products. DVD Video. Your Name. Add to Cart.