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Shoulder Separations
The
acromioclavicular joint (the
AC joint), is made up of the lateral end of the
clavicle
(the
collarbone), and a bony shelf
from the
scapula, called the
acromion
process. This joint is held together by a capsule and a number of important
ligaments which also attach to the coracoid process, a small bone projecting
from the scapula just below the AC joint. The most common means of injury to the
AC joint is a direct blow downward on the top, or point, of the
shoulder.
AC joint sprains can be classified into three categories: Grades I, II, and III.
Grade I involves a mild stretching of the joint capsule and
ligaments with no obvious deformity and some
tenderness and
swelling.
Grade II involves a significant tearing of the
ligaments and obvious deformity.
Grade III is a complete disruption, or tear, of
the ligaments with significant joint deformity. The usual treatment for this
injury is a figure eight splint to keep the joint immobile while the healing
process occurs. Grade III, or complete
tears, used to be treated with
surgery, but are now treated conservatively, except in cases where there is
an associated
fracture or the clavicle is grossly out of place.
This is another example of studies showing that the best approach is the most
conservative approach. While the initial
immobilization
may relieve pain,
weakening of the ligaments will occur if the immobilization continues
indefinitely. Physical therapy and an exercise program may restore strength and
function to the shoulder, but the injured ligaments may continue to grind, pop,
click, and cause pain, especially with overhead activities and when reaching
across the chest. Because these activities put strain on the ligaments, the
surrounding muscles may go into spasm and become chronically painful, inhibiting
the athlete's ability to use the shoulder normally. The physician will note
tenderness with possible deformity over the AC joint and tenderness at the coracoid process. A positive jump sign may also be noted when the physician
palpates the surrounding muscles. One point to remember is that a grinding or
crunching sound in any joint is not normal. This is a sign of
ligament laxity causing excessive
joint motion, producing the grinding sensation.
Once first line treatments have been unsuccessful,
Prolotherapy will provide the answer.
Injections made at the AC joint and at the insertion of the ligaments on the
clavicle, coracoid process, and acromion process will initiate a healing process
in these structures and will result in the resolution of pain and a return of
normal function. The Prolotherapy, by strengthening the AC joint and the many
structures that attach to the coracoid, makes an athlete's shoulder much more
stable. As the shoulder becomes more stable, it follows that athletic
performance is enhanced. |
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