Dislocation of the clavicle (acromioclavicular joint)
This injury consists in the complete or incomplete rupture of ligaments that keep the opposite ends of acromion and clavicle joined. The consequence is an upwards dislocation, associated with pain and impossibility to move the shoulder.
Injuries to this joint usually are direct (a fall onto the shoulder, cycling, football, traumatic contact) with a load going downwards.
The symptomatology is characterised by local pain and deformity of the acromioclavicular profile.
The clinical conditions are however variable, according to the entity of damages.
The radiological exam supplies specific projections for the acromioclavicular joint. The echographic examination can as well underline ligament lesions and provide information about the level of the dislocation. The MRI scan is suggested in case other injuries are suspected, such as the one of the rotators cuff.
Treatment is usually conservative and consists in the immobilisation of the articulation for almost 20 days. This resolution allows the injured structures to heal in the best position, even if it is necessary at the removal of bandage a period of rehabilitation to restore movement and recover strength, elements that inevitably are compromised by the trauma in itself as well as by the forced rest.
If the lesion was complex, recurring to surgery is unavoidable to take the two articular ends next to eachother.
Dislocation of the clavicle – Rehabilitation
The acromioclavicular joint injuries are categorized in relation to the extent of ligament rupture (going from incomplete injury to the complete one) and the direction of the dislocation of the clavicle, resulting in different diagnostic pictures.
Most of these have a similar therapeutic development that starts with the immobilization brace for 2/4 weeks; common symptom is pain which can persist for a long period of time.
Eliminated the guardian it is necessary to start early rehabilitation program with the primary goal of controlling pain through physical therapy (laser, tens, ice), relaxing massage and stress relieving of the periarticular structures and reflexology piriformis; parallel you can start a mobilization work with reduced ROM (from the third week) with gradual increase of range of motion both in the pool and in the gym.
Once you get to the full ROM you can start recovery of strength through isometric exercises of the rotator cuff muscles and scapular stabilizers; gradually will be included isotonic exercises and reinforcement for the supraspinatus and deltoid and eccentric exercises of the rotator cuff.
The rehabilitation program concludes with field exercises that consist in launching and gripping objects on different surfaces, movement education, and prevention of re-injury.
