Acromioclavicular Joint Problem in Athletes. Issue 2 (31st January 2023) - Prasetia, Renaldi
Introduction: Acromioclavicular (AC) joint separations account for 12% of all shoulder injuries. People doing high-energy physical activities such as athletes are at risk for AC joint separation. The mechanism of injury could be direct or indirect. Direct mechanism involves a direct blow to the AC and coracoclavicular (CC) ligaments. Indirect mechanism happens when the injury force hits the AC joint indirectly, involving axial compression, as seen in a fall with an extended arm, where caput humeri is pressed against the acromion. The purpose of this paper is to elaborate on AC joint problems in athletes by reviewing literatures. Review: Patients with AC joint injury will exert complaints of pain and be unwilling to lift the affected arm, implying mobility function impairment. Signs such as skin abrasions and bruises can be found during inspection. A prominent distal clavicle is a pathognomonic sign of dislocation of the AC joint. A well-known classification for AC joint separations, Rockwood classification, divides the separations into six types. The classification helps determine different managements and prognoses for each of the AC joint separation types. Athletes should be treated in consideration of their position in the sports season. For athletes in season, pain should be treated as the priority. Absolute indications for surgical management are then identified to help determine the athlete's return-to-play capability. For out-of-season athletes with AC injury, look for absolute or relative indications for operative management. If there is no indication, plan for rehabilitation. But if there are some indications, either absolute or relative, plan for surgery immediately. Complaints of pain and functional disabilities such as motion should be carefully assessed and managed. To determine suitable management, the injury should be classified properly. Type I and II injuries are treated with nonsurgical management. For type IV and VI injuries, surgical intervention is needed. AC joint separation Rockwood type III and V both had complete AC and CC ligament tear but repair is adequate for acute type III AC injury while reconstruction is needed for type V AC injury. Conclusion: AC joint separations should be treated as joints, not as bones where compressions are applied therefore limiting movements. Repair and reconstruction indications should be properly assessed on patients to ensure functions returned to their pre-injury state which is important for athletes' return to sports.