Description
Dislocations of the collar bone from its joint with the acromion process are common injuries. They occur due to a fall on the point of the shoulder in sports, vehicular accidents and falls. The upper limb is suspended from the collar bone at the acromioclavicular joint by strong ligaments and joint capsule. Disruption of these ligaments leads to a downward dislocation of the entire upperlimb from the clavicle by its own weight.
Symptoms & Signs
There is pain at the tip of the shoulder. There is also a prominence of the shoulder tip as compared to the opposite side. In severe cases the collar bone can be moved independent of the shoulder blade. Range of movement of the shoulder joint is not affected. In late and neglected cases there is a perceptible weakness of the upper limb and an aching pain on performing overhead activities.
Diagnosis-
Is usually accomplished by eliciting a proper history and the increased prominence of the collar bone. In suspected mild cases stress X rays of both joints may be needed to unmask the dislocation. Xrays are needed in two planes to determine the direction of dislocation in the horizontal plane.
Treatment-
Mild cases with only a sprain of the joint capsule need only conservative treatment like rest in a sling for about two to three weeks and mobilization. Severe cases ( grade III to VI ) may need anatomical reduction by an open method, fixation and suture of the damaged ligaments particularly in young patients. In late cases a reconstruction of the ligaments and excision of the lateral end of the clavicle are needed. Neglected cases can lead to acromio clavicular arthritis.
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