AC joint dislocation
Your acromioclavicular (AC) joint is formed where your collarbone (clavicle) meets your shoulder blade (scapula) at the part known as the acromion process. Dislocation of this joint normally happens as a result of a direct blow from a high point on the top of the shoulder, and this may occur in a number of contact sports for example. A dislocation of this joint can be very painful and limiting.
However, good, effective treatment is available to help get you out of pain and back to better function as soon as possible. It’s easy to arrange a consultation with me at Circle, and as there are no waiting lists, I can help get you back to full strength again without delay.
When I first meet with you, there will be two questions I will be looking to answer; what type of AC joint dislocation have you had and what exactly caused it? The answers to these two questions will help me determine the best course of action.
I will also want to know what level of function you are hoping to regain from any treatment, as this can vary quite a lot for different people. For example:
- Are you a professional rugby player needing to recover and return to competitive sport again as quickly as possible?
- Are you looking to return to sports purely as a hobby?
- What sort of job do you have? (If you’re a plumber for example, you will probably spend a lot of time moving your arm and shoulder into awkward positions to access pipes etc., so you will need to know for certain that your shoulder is stable.)
I will also want to know whether you have any associated injuries, such as a numbness or tingling down the arm, or a weakness in it that is new since the dislocation. These can be signs of nerve or tendon damage (although thankfully they are relatively rare.)
The AC joint has many ligaments directly surrounding it, as well as very strong ligaments further away from the joint that connect the shoulder blade to the collarbone. The type of dislocation you have will depend on which ligaments have been injured and how extensive the damage to them is.
Dislocations are graded between 1-6. One is like a tiny sprain, while six would describe a pretty awful dislocation that is only very rarely seen. The grading is made based on physical assessment and examination as well as diagnostic images, such as MRI scans or X-rays of the shoulder. These imaging methods can help to give a good idea of how much the bones of the joint have separated.
In general terms, the smaller sprains (grade 1-2) can be successfully treated conservatively. This means that if they are rested, they will tend to settle down after 3-4 months. You may well have a minor prominence of your AC joint, but normally it will still function very well, and without pain. Most rugby players will have this kind of injury at some stage.
Often with grades 3-4 dislocations, a good proportion will settle conservatively. Should you have suffered this level of dislocation, we will have a discussion about treatment options and you may well decide to opt for conservative treatment for 3-4 months. This could well be all you need.
Where the dislocation is graded as a 4-6, treatment will almost certainly require surgery to restore function. Within these gradings, the joint may be quite wide apart, it may be completely disrupted, and the bone may even have gone into muscle. It will be very painful, and you will not have much function in your arm as a result. Should you see me fairly quickly after dislocating the joint to this extent, surgical repair can usually be carried out arthroscopically (this is a form of keyhole surgery). After three weeks or so of the injury, you will probably need to have traditional ‘open’ surgery to reconstruct the joint.
Surgery is done under general anaesthetic as a day case, meaning you will be able to go home the same day. Your arm will need to be in a sling for about two to three weeks, then our Circle physiotherapy team will work with you to help strengthen and restore function your shoulder.
Most people will be back to normal again after 12-14 weeks of the surgery, although I have recently treated a lot of triathletes and other athletes who have fallen or come off their bike, who have been able to return to swimming and running after around 6-8 weeks. I always emphasize the importance of recovering at your own pace. After all, a proper recovery is always more important than a rushed one.
I had injured my right shoulder 12-13 years ago, but as it was only a fairly mild injury (a grade 2) it was treated conservatively. More recently, I was playing football when I injured my left shoulder. This was a more significant injury than I had previously had on the other shoulder, and I was diagnosed with a grade 4 dislocated AC joint.
I’m a respiratory consultant myself but have a number of orthopaedic consultant friends, so I asked one of them (who was a knee specialist) who they would recommend. They told me that Andrew Chambler at Circle was the person I should see.
I saw Andrew at Circle and talked with him about things. I was quite surprised when he told me that I would need surgery to repair the joint. However, he explained that while I would be able to function ‘okay’ without surgery, I would be limited in certain activities and movements; certainly, it would limit my ability to participate in certain sports. Certainly, from the X-ray of my shoulder I could see there was a pronounced dislocation visible.
I opted to have the surgery, which was a day case procedure and went well. Despite Andrew advising me on what I should expect in terms of recovery times, I did underestimate how long it would take me to fully recover and be back to full function again (I’m sure I’m not the only person guilty of this). It turns out that Andrew knows what he’s talking about.
Since having the surgery, I am now back to playing football and have also started playing some rugby. I am able to tackle with confidence using my left shoulder and am not apprehensive at all that my shoulder might not be strong enough. I am really enjoying being able to be fully engaged in a physical sport like rugby without having to try to protect my shoulder.
Andrew had explained before the surgery that the joint would be stronger than the other one afterwards, and this is giving me the confidence to play rugby and football. I am able to enjoy the activity itself instead of constantly worrying about the risk of injuring it again.