Separate shoulders , also known as acromioclavicular joint injury , are common injuries to acromioclavicular joints. The AC joint is located at the outer end of the clavicle where it is attached to the scapula acromion. Symptoms include pain that can make it difficult to move the shoulder and often experience deformity.
This happens most often because it falls to the front and top of the shoulders when the arms are on the side. They are classified as type I, II, III, IV, V, or VI with higher rates of more severe injury. Diagnosis is usually based on physical examination and X-rays. In type I and II injuries occur minimal deformity while in type III injury the deformity disappears after lifting the arm upwards. In type IV, V, and VI deformities do not resolve by lifting arms.
Generally types I and II are treated without surgery, whereas type III can be treated with or without surgery, and types IV, V, and VI are treated by surgery. For the treatment of type I and II usually with sling and pain medication for one or two weeks. In type III wound surgery is generally only done if the symptoms still follow the treatment without surgery.
Separate shoulders are a common injury among those involved in sports, especially contact sports. It makes up about half of the shoulder injuries among those who play hockey, football, and rugby. Those affected are usually 20 to 30 years of age. Men are more affected than women. The injury was originally classified in 1967 with the current classification from 1984.
Video Separated shoulder
Penyebab
Separate shoulders often occur in people who participate in sports such as soccer, soccer, horse riding, hockey, parkour, sports combat, rowing, rugby, snowboarding, skateboarding, whip cracking, biking, roller derby, and wrestling. Separation is classified into 6 types, with 1 to 3 increase in severity, and 4 to 6 being the most severe. The most common injury mechanism is to fall at the tip of the shoulder or also fall on the outstretched hand. In falls where the force is transmitted indirectly, often only the acromioclavicular ligaments are affected, and the coracoclavicular ligaments remain unharmed. In ice hockey, separation is sometimes caused by lateral forces, such as when one is forcibly entering the side of the arena.
Maps Separated shoulder
Mechanism
Acromion of the scapula is connected to the clavicle by a superior acromioclavicular ligament. The coracoclavicular ligament connects the clavicle to the coracoid process. The two ligaments that form the coracoclavicular ligament are trapezoidal and conoid ligaments. These three ligaments add support to the shoulder joint.
There are four types of soft-tissue disorders that can cause acromioclavicular separation:
- Conoideum and trapezoid ligaments can be torn at any location
- The lateral clavicle may rise upward after the avulsion of the periosteum
- Acromioclavicular ligaments may tear
- The origin of the cono-trapezoidal ligaments can be avulsed from coracoid
Diagnosis
The diagnosis is based on physical examination and x-ray. Physical examination may identify tenderness, pain in AC joints with cross-arm adduction, and pain relief with a local anesthetic injection. The cross-arm adduction will produce special pain in the AC joint and will be done by lifting the arm to a 90 ° angle, stretching the elbow to a 90 ° angle, and adding the arm to the chest. Pain in the shoulder is difficult to determine the innervation of the joints of AC and glenohumeral joints. Injury to the AC joint will cause pain over the AC joint, in the anterolateral neck and in the region within the anterolateral deltoid.
X-rays show a separate shoulder when the acromioclavicular joint space is widened (usually 1 to 3 mm, and decreases with age).
These can be classified into 6 types.
Type I
Type I air separation involves direct trauma to the shoulder causing injury to the joint ligaments, but no tear or heavy fracture. Usually referred to as a sprain.
Type II
Type II AC separation involves a complete rupture of the acromioclavicular ligaments, as well as a partial tear of the coracoclavicular ligament. This often causes a bump that is visible on the shoulder. This lump is permanent. The clavicle is unstable for direct stress checks. On radiography, the lateral end of the clavicle may be slightly higher by pressing on the sternal aspect of the clavicle that forces the acromial tip downward, and by releasing it, it can reappear by raising the piano key mark due to the tearing of the AC. Severe pain and loss of movement often occur.
Type III
In AC type III separation the acromioclavicular and coracoclavicular ligands were torn without significant interference with the deltoid or trapezial fascia. A significant lump, resulting in a shoulder deformity, is formed by the lateral end of the clavicle. This lump, caused by a clavicle dislocation, is permanent. The clavicle can be removed and out of place on the shoulder. Radiographic examination, will show results as abnormal. Pain with movement can be severe.
Type IV
This is a Type III injury with a coracoclavicular ligament avulsion of the clavicle, with the clavicle distal to the posterior inward or through the trapezius and may close the posterior skin. Abandoned clavicle is easily seen on the radiograph. It is important to evaluate the sternoclavicular joint as well, since anterior dislocation of the sternoclavicular joint and posterior dislocations of the AC joint may occur. This injury is generally acknowledged to require surgery.
Type V
This is a more severe form of type III injury, with the trapezial fascia and deltoid removed from acromion and clavicle. This is a type III but with an exaggeration of the vertical displacement of the clavicle from the scapula. Distinguishing between Type III and Type V separations based on radiography is difficult and often unreliable among surgeons. Type V is manifested by an increase of 2 to 3 times the coracoclavicular distance. The shoulders manifest as heavy droop, secondary to shifting of the scapula and the humerus downward due to loss of clavicle strut. These injuries generally require surgery.
Type VI
This is a type III with an inferior dislocation of the distal end of the clavicle beneath the coracoid. This injury is associated with severe trauma and is often accompanied by several other injuries. This mechanism is considered as severe hyperviduction and external rotation of the arm, combined with a retraction of the scapula. The distal clavicle is found in 2 orientations, either subacromial or subcoracoid. With subcoracoid dislocations, the clavicle becomes lodged behind intact conjunctival tendons. The superior posterior AC ligament, which is often attached to the acromion, can move to the AC interval, making the anatomical reduction difficult. The tissue needs to be cleaned by surgery and then reconnected after being reduced. Most patients with type VI injuries have paresthesia resolved after clavicle relocation. This is very rare and is generally only involved with motor vehicle collisions. This requires surgery.
Treatment
Separate shoulder treatment depends on the severity of the injury. When starting treatment, the first step should be to control the inflammation, and to rest and ice together. Anti-inflammation such as Advil or Motrin can also relieve pain and inflammation. The joints should be ice every four hours for fifteen minutes each time. One can wear a sling until the pain subsides; then a simple exercise can begin.
Non-surgical
Shoulder type I and Type II separation are the most common types that are separated and rarely require surgery. However, the risk of arthritis with type II separation is greatly increased. If it becomes severe, a Mumford procedure or a distal clavicle excision may be performed.
Most non-surgical treatment options include physical therapy to build muscle and help stabilize joints. Literature on long-term follow-up after type III injury surgery repair is rare, and those who are treated nonoperatively generally do well enough. Much research has come to the conclusion that non-surgical treatment is as good or better than surgical treatment, or that anything achieved by surgery is very limited. It seems that after a while, the body "remodels" the joint, either expanding the distal clavicle or causing it atrophy. There may also be potential that surgical repair may be less painful in the long term.
After the pain subsides, range-motion exercises can be started followed by a strength training program. Strength training will include the strengthening of the rotator cuff, and the blade muscles. With most cases, the pain disappears after three weeks. Although full recovery may take up to six weeks for Type II and up to twelve weeks for Type III.
Those with separate shoulders will most often return to full function, although some may continue to ache in the area of ​​the AC joint. With the ongoing pain there are several things that may cause it. Probably because the abnormal contact between the bones ends when the joint moves, the development of arthritis, or injury to a piece of cartilage pads found between the joints of this joint.
Surgery
Type IV, V, and VI shoulder splits are very rare but always require surgery. There is some debate among orthopedic surgeons, however, about the treatment of shoulder type separation. Many with type III shoulder separations that do not undergo surgical treatment heal as well as those who receive them, and avoid any additional risks that may be present in the surgery. Those who opt out of surgery also have a faster recovery time and can get back to work or exercise faster. Several studies have shown that early type III surgery can benefit workers and athletes who perform overhead movements. The potential benefits of surgical treatment for type III remain unproven. Studies have been made that those who perform surgery or not will require some type of surgery later in the road. Damaged joints are much faster than normal and over time it can become rheumatic and painful.
There are many operations described to improve complete acromioclavicular separation, including recent arthroscopy. There is no consensus about which operations are best. Some operations have been described with pins or hooks. Another operation performs muscle transfer.
General surgery is some form of Modified Weaver-Dunn procedure, which involves cutting off the end of the clavicle, partially sacrificing the korakoacromial ligament and stitching the acromial ends that are displaced onto the lateral aspect of the clavicle for stabilization, then often additional support forms are introduced to replace the coracoclavicular ligament (s). Variations of this support include transplanting the tendon from the foot. or the use of synthetic stitching or anchor stitching Other operations have used the Rockwood screw originally inserted and then removed after 12 weeks. Physical therapy is always recommended after surgery, and most patients get back flexibility, although it may be somewhat limited.
After a person has surgery, a sling should be worn to support and protect the shoulder for several days. For the first pair of physical therapy visits, care will focus on controlling the pain and swelling. This type of treatment may include, ice and electrical stimulation, massage, or other treatments to help relieve muscle aches and spasms. After about four weeks, various motion exercises can begin. Passive exercises are performed where the shoulder joint is removed but the muscles remain relaxed. After about six to eight weeks, active therapy begins. Such exercises can include isometric strengthening that exercises the muscles without suppressing joint healing. After about three months, more active reinforcement will be included which focuses on increasing the strength and control of the rotator cuff muscles and muscles around the shoulder blades. Exercises given by the therapist to the patient to do at home should be done in order to get a better recovery in the long run.
Physical therapy
Some physical therapy exercises that can be done to help shoulder rehabilitation are: While standing and using theraband you can do Y, T, and me, internal shoulder rotation, external shoulder rotation, Shoulder extension, and squeezing scapula When lying on your side you can do internal rotation and external rotation with light weight. The light weight can be a kind of object such as a 1-5 pound dumbbell weight, or a canned soup. Also you can roll the pectorals rolls. With a foam roller you can also lie on your back on it and do a snow angel.
See also
- Other shoulder issues
References
External links
- Roda Online sumber ortopedi online (untuk ortopedi)
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Rollo J, Raghunath J, Porter K (Oktober 2005). "Cedera pada sendi acromioclavicular dan pilihan pengobatan saat ini". Trauma . 7 (4): 217-223. doi: 10.1191/1460408605ta349oa. Diarsipkan dari aslinya pada 2006-10-17.
Source of the article : Wikipedia
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