Featured Research

from universities, journals, and other organizations

Surgeons Disagree On Best Treatment For Healing A Moderate Shoulder Separation

Date:
April 1, 2009
Source:
American Academy of Orthopaedic Surgeons
Summary:
While low-level shoulder separations can commonly be treated nonsurgically and high-level injuries often require surgery, a literature review finds that many surgeons still disagree on the best course of treatment for those injuries that fall in between.

This figure shows the intact ligaments around the acromioclavicular joint. The red arrow points to the ligaments that are around the joint itself. The gray arrow points out the important stabilizing ligaments underneath the collarbone.
Credit: Copyright American Academy of Orthopaedic Surgeons

While low-level shoulder separations can commonly be treated nonsurgically and high-level injuries often require surgery, a literature review published in the April 2009 issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS) finds that many surgeons still disagree on the best course of treatment for those injuries that fall in between.

Shoulder separations, clinically known as acromioclavicular joint injuries, represent nearly half of all athletic shoulder injuries.

These injuries result from a fall onto the tip of the shoulder with the arm tucked in toward the body.

"Shoulder separation" is not a truly accurate term for this type of injury, which is not a separation of the shoulder joint itself, but rather a disruption or dislocation of the acromioclavicular joint (also called the AC joint), where the collarbone (clavicle) meets the highest point of the shoulder blade (acromion).

If the force of the fall is severe enough, the ligaments attaching to the underside of the clavicle may also be torn. The severity or "type" of injury is classified by the amount and direction of joint separation seen on x-rays. If the underside of the clavicle is torn, it is referred to as a major injury. Signs and symptoms of AC joint injuries range from a minor deformity and mild pain, to a very painful, severe deformity. However, even more serious separations can often be treated successfully with proper attention.

"AC joint injuries are not benign and should not be ignored," says Ryan Simovitch, MD, orthopaedic surgeon specializing in the shoulder, Palm Beach Orthopaedic Institute, Palm Beach Gardens, Florida. "Nonsurgical treatment does not mean you can neglect the injury. Many patients who follow appropriate treatment and a rehabilitation program can have clinical success without surgery. At the same time, surgery has an important role in high grade injuries."

Nonsurgical options – which help treat the injury and manage pain for minor sprains (clinically called type I and II AC joint injuries) of the shoulder ligaments include:

  • slings
  • cold packs
  • over-the-counter pain and anti-inflammatory medications

Sometimes, other types of supports may be used to help lessen AC joint motion and reduce pain. Surgery is almost always recommended for major or high level injuries (also called type IV, V, and VI injuries), as well as less serious injuries that do not respond to nonsurgical treatment. Both surgical and nonsurgical types of treatment must include rehabilitation to restore and rebuild the patient's motion, strength, and flexibility.

The treatment of the mid level injuries (type III) remains controversial, with nonsurgical treatment favored in most instances and surgical reconstruction of the acromioclavicular joint reserved for cases in which the joint demonstrates persistent instability.

"Nearly 50 years after the initial papers describing type III acromioclavicular joint injuries, there is still a lack of consensus on the best treatment for them," Simovitch says. "So far, most studies do not show a significant difference in outcomes between nonsurgically and surgically treated patients with this type of injury. Also, while most orthopaedic surgeons agree that type IV and higher injuries should be treated surgically, we haven't reached a consensus on which surgical technique is best. Over the years, however, arthroscopic and open treatment options for AC joint reconstruction have made significant advances."

Although the issue has not been fully researched, the study authors suggest that certain patients with Type III injuries, such as heavy laborers and athletes who perform frequent overhead motions, might benefit more from surgical reconstruction.

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.


Story Source:

The above story is based on materials provided by American Academy of Orthopaedic Surgeons. Note: Materials may be edited for content and length.


Cite This Page:

American Academy of Orthopaedic Surgeons. "Surgeons Disagree On Best Treatment For Healing A Moderate Shoulder Separation." ScienceDaily. ScienceDaily, 1 April 2009. <www.sciencedaily.com/releases/2009/04/090401102139.htm>.
American Academy of Orthopaedic Surgeons. (2009, April 1). Surgeons Disagree On Best Treatment For Healing A Moderate Shoulder Separation. ScienceDaily. Retrieved April 23, 2014 from www.sciencedaily.com/releases/2009/04/090401102139.htm
American Academy of Orthopaedic Surgeons. "Surgeons Disagree On Best Treatment For Healing A Moderate Shoulder Separation." ScienceDaily. www.sciencedaily.com/releases/2009/04/090401102139.htm (accessed April 23, 2014).

Share This



More Health & Medicine News

Wednesday, April 23, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Big Pharma Braces for M&A Wave

Big Pharma Braces for M&A Wave

Reuters - Business Video Online (Apr. 22, 2014) Big pharma on the move as Novartis boss, Joe Jimenez, tells Reuters about plans to transform his company via an asset exchange with GSK, and Astra Zeneca shares surge on speculation that Pfizer is looking for a takeover. Joanna Partridge reports. Video provided by Reuters
Powered by NewsLook.com
Study Says Most Crime Not Linked To Mental Illness

Study Says Most Crime Not Linked To Mental Illness

Newsy (Apr. 22, 2014) A new study finds most crimes committed by people with mental illness are not caused by symptoms of their illness or disorder. Video provided by Newsy
Powered by NewsLook.com
Hagel Gets Preview of New High-Tech Projects

Hagel Gets Preview of New High-Tech Projects

AP (Apr. 22, 2014) Defense Secretary Chuck Hagel is given hands-on demonstrations Tuesday of some of the newest research from DARPA _ the military's Defense Advanced Research Projects Agency program. (April 22) Video provided by AP
Powered by NewsLook.com
How Smaller Plates And Cutlery Could Make You Feel Fuller

How Smaller Plates And Cutlery Could Make You Feel Fuller

Newsy (Apr. 22, 2014) NBC's "Today" conducted an experiment to see if changing the size of plates and utensils affects the amount individuals eat. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

    Health News

    Environment News

    Technology News



    Save/Print:
    Share:

    Free Subscriptions


    Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

    Get Social & Mobile


    Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

    Have Feedback?


    Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
    Mobile: iPhone Android Web
    Follow: Facebook Twitter Google+
    Subscribe: RSS Feeds Email Newsletters
    Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins