Acromioclavicular Joint Dislocation Specialist Singapore

If you suspect you have a dislocated AC joint, you should seek immediate medical attention. This is because treatment is much easier and you have a much better chance of excellent recovery if the injury is treated early.

The first thing is to confirm the diagnosis. This is easily done with a simple x-ray. Often it is prudent to do x-rays of both shoulders to compare both sides. This is because some patients’ clavicles naturally sit slightly high giving the appearance it could be slightly out of place.

Comparing the uninjured side with the injured side allows your doctor to not only confirm the injury, but also allows him to grade its severity. This is important because milder injuries will do fine without any invasive surgery to fix the joint, but more severe injuries may require surgical fixation.

Besides x-rays, some doctors may also recommend doing an MRI scan. This mainly useful for looking for other associated injuries. A number of patients with ACJ dislocations may also suffer concomitant injuries like labral tears. Please refer to the section on Investigations to learn more about MRI scans.

The objective of surgery is to put the ACJ back in place and keep it in place. Many techniques have been developed to achieve this over the years. Many failed and have become historical. Many shoulder surgeons will treat acute injuries differently from chronic injuries. I generally regard injuries less than 2 weeks old as acute.

For acute injuries, I usually use one of 2 methods, depending on patient preference and size of the patient. For large and heavy-set patients, I use a strong hooked plate which levers against the inferior surface of the acromion to push the clavicle down and keep it in place.

This is an excellent and extremely strong method of holding the ACJ stabilized, but a big drawback is the need to remove the plate after a period of about 5 – 6 months. By that time, the ACJ and CC ligaments would have healed.

If the plate is not removed, it may cause irritation and pain when patients lift their arms overhead by impinging on the underlying rotator cuff tendon.

For smaller patients, I use a suspensory type fixation, where a hole is drilled through the clavicle and the base of the coracoid process. The ACJ is then brought back into place and held by passing strong suture tapes through the holes, secured over the clavicle and under the coracoid with small metal buttons.

This surgery is done via keyhole surgery and there is no need for a second surgery to remove the metal buttons. Please see section on keyhole surgery if you would like to know more about keyhole surgery.

Finally for chronic injuries, I use either one of the above techniques, but I loop a tendon graft around the clavicle and the coracoid process so that the body can, over time, convert the tendon graft into a new ligament to help hold the ACJ in place.

A tendon graft is a tendon which is either harvested from the patient’s leg or a commercially prepared tendon procured from deceased donors.

The need to loop a tendon graft increases the complexity of the surgery and there is some evidence that ACJ injuries which are treated early (acute injuries) tend to do better thanchronic ones.

Absolutely. The aim of the surgery is to restore stability to your shoulder, not just during daily activities, but also during sports.

Unfortunately acromioclavicular joint dislocations are often accidental injuries and there is not a lot you can do to prevent it from happening.

Symptoms include pain, swelling, bruising, tenderness over the shoulder, and a visible bump or deformity on the top of the shoulder.

AC joint dislocations are classified into different grades. Grade I may require rest and therapy, while Grade IV and above often necessitate surgery.

Untreated dislocations can lead to chronic pain, joint instability, and decreased shoulder function over time.

It is important to avoid overhead movements, heavy lifting, and activities that strain the shoulder during recovery.