Sport Surgeon

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Acromioclavicular Joint (ACJ) Dislocation - Shoulder Injury

This is most commonly injured following direct trauma to the shoulder or from a fall onto an outstretched arm. This is a very common rugby injury.

Clinical image of grade 3 ACJ dislocation

The immediate symptoms are pain and deformity at the end of the collarbone. X-rays will usually show most injuries sometime stress films are required or even an MRI scan. Except for the most severe injuries the treatment is conservative. Most of the initial symptoms will settle over a six to eight-week period and during this time your physiotherapist will keep you mobilising, a sling can be used for comfort during this period.

X-ray of ACJ dislocation

We will do an MRI scan usually to exclude other injuries. When you are examined in the first few weeks it is often possible to determine whether this is a stable injury and whether conservative treatment will be successful. This will leave a prominent bone, but one which is usually not painful.

Surgery has it place but its role is controversial. One of the issues is the surgery is not simple and not without risks. It can be done arthroscopically or open. If required I use an artificial graft with an open technique as this is most reliable to replace the torn ligaments. This requires extensive rehabilitation and is best left if the shoulder continues to cause significant issues. Like many of these things this is best discussed directly so you can understand the pros and cons of each approach.

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