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Sprains of the acromioclavicular joint (Grade I and II dislocations) may be more severe than previously thought

Authors: Mouhsine et al.

References: J Shoulder Elbow Surg 2003;12:599-602

Abstract
A surprisingly high rate of complications, including pain, radiographic changes and need for surgery, are noted after conservative treatment of grade I and II acromioclavicular (AC) joint sprain, according to a 6-year follow-up study.

AC joint injuries are common lesions, particularly in athletes. Grade I and II sprains are typically considered to have a good prognosis and it is therefore thought that such injuries can be managed with conservative treatment. However, studies have rarely reported the percentage of success or effects on joint instability.

Elyazid Mouhsine, MD, and colleagues at the University Hospital of Lausanne, Switzerland, evaluated the outcome of acute grade I and II AC joint sprains that were treated by conservative measures.

The study included 28 men and five women with grade I and II AC joint sprains and a mean age of 25 years. Patients were treated with ice application, analgesics, and an arm sling for five to 21 days, followed by a rehabilitation program. Clinical and radiographic examination was conducted in patients who did not fail treatment. These patients were followed for a mean of 6.3 years.

At final follow up, 52% of patients were asymptomatic and seven patients reported pain or discomfort in the affected joint during physical effort. Furthermore, nine patients had chronic AC joint pathology and required surgery a mean of 26 months after injury.

A pathologic anteroposterior AC laxity was noted in eight patients, all of whom had grade II injury and half of whom had shoulder pain. Notably, none of the patients had abnormal superoinferior laxity. Painful palpitation of the AC joint was also reported in 10 patients.

Radiographic analysis revealed that 13 patients had degenerative changes in the AC joint. It also found ossification in the coracoclavicular ligaments in two patients, an association of degenerative changes with ossification of the coracoclavicular ligaments in three patients, and distal clavicular osteolysis in three patients.

Only four patients did not show signs of radiographic changes.

The authors "maintain that the severity of grade I and II AC joint injuries is underestimated in the current literature and may lead to more chronic disability than previously recognized, especially in athletes and heavy laborers who stress their shoulder daily."

However, they "do not recommend primary operative treatment, as more than 50% of the patients reported having a good or excellent shoulder 6 years after the injury" and "secondary surgical options still exist with reliable results."

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