Anatomy of the AC Joint
The collarbone (clavicle) attaches to the roof of the shoulder (acromion) in a joint referred to as the acromioclavicular (AC) joint. This area is easily defined because it is the bump that you can feel on the top of the shoulder. This area is stabilized by strong ligaments called the coracoclavicular (CC) ligaments, which attach the collarbone to the front of the shoulder blade (scapula), in addition to the AC ligaments surrounding the joint.
What is an AC Joint Injury?
Injuries to the AC joint are quite common among athletes. Shoulder specialist, Dr. Robert Boykin treats AC joint injuries for patients in Asheville, Arden, Fletcher and surrounding North Carolina communities. Direct trauma to this area (such as a football hit or falling over the handle bars on a bike) can disrupt these connections and lead to a scenario where the collarbone and acromion are no longer aligned correctly. These injuries are also called a “shoulder separation” and are measured based on grades. A Grade 1 or 2 AC joint injury will lead to pain and usually indicates the ligaments are stretched or sprained. These injuries can often be treated with rest and a sling followed by a short physical therapy program. A Grade 3, 4, 5, or 6 separation means a ligament tear is most likely present. This leads to elevation of the collarbone that can often be felt at the top of the shoulder. In these situations (Grade 4, 5, 6 and some Grade 3), surgery may be warranted because chronic shoulder pain and weakness can occur on a daily basis following the initial injury.
What is an AC Joint Repair?
Dr. Boykin performs AC surgery arthroscopically. The goal of arthroscopic AC repair is to secure the collarbone back into its normal position and ensure that all bones are aligned properly to give the shoulder a stable platform for function. Dr. Boykin accomplishes this by attaching very strong sutures to the collarbone and to the front of the shoulder blade. In certain cases this is accompanied by reconstruction of the CC ligaments, which involves looping a graft (either from the patient or donated) from the front of the shoulder blade to the top of the collarbone. Dr. Boykin performs this surgery with the use of the arthroscopic camera as well as small incisions around the shoulder. This surgery is completed on an outpatient basis, and in most cases patients are able to begin a physical therapy program immediately.
Physical therapy is a very important part of the recovery process. Following arthroscopic AC repair surgery, patients will start shoulder motion under the direction of a therapist and will continue to wear a sling for protection for a number of weeks (usually 4-6) post-operatively. Eventually, after the ligaments heal, patients will be allowed to progressively strengthen the shoulder and the use of the sling will no longer be needed. Return to sports will be a gradual, steady process. Within 4 months following surgery, Dr. Boykin often releases patients for a full return to activities depending on their overall progression towards a full recovery.
For more information on AC joint injuries, or to learn more about arthroscopic AC repair, please contact the office of orthopedic shoulder surgeon Dr. Robert Boykin, serving Asheville, Arden, Fletcher and surrounding North Carolina communities.