Acromioclavicular joint (AC joint) dislocation or shoulder separation is one of the most common injuries of the upper arm. It involves separation of the AC joint and injury to the ligaments that support the joint. The AC joint forms where the clavicle (collarbone) meets the shoulder blade (acromion).
It commonly occurs in athletic young patients and results from a fall directly onto the point of the shoulder. A mild shoulder separation is said to have occurred when there is AC ligament sprain that does not displace the collarbone. In more serious injury, the AC ligament tears and the coracoclavicular (CC) ligament sprains or tears slightly causing misalignment in the collarbone. In the most severe shoulder separation injury, both the AC and CC ligaments get torn and the AC joint is completely out of its position.
Symptoms of a separated shoulder may include shoulder pain, bruising or swelling, and limited shoulder movement.
The diagnosis of shoulder separation is made through a medical history, a physical exam, and an X-ray.
Conservative treatment options
Conservative treatment options include rest, cold packs, medications, and physical therapy.
Surgery may be an option if pain persists or if you have a severe separation.
Of late, research has been focused on improving surgical techniques used to reconstruct the severely separated AC joint. The novel reconstruction technique that has been designed to reconstruct the AC joint in an anatomic manner is known as anatomic reconstruction. Anatomic reconstruction of the AC joint ensures static and safe fixation and stable joint functions. Nevertheless, a functional reconstruction is attempted through reconstruction of the ligaments. This technique is done through an arthroscopically assisted procedure. A small open incision will be made to place the graft.
This surgery involves replacement of the torn CC ligaments by utilizing allograft tissue. The graft tissue is placed at the precise location where the ligaments have torn and fixed using bio-compatible screws. The new ligaments gradually heal and help restore the normal anatomy of the shoulder.
Postoperative rehabilitation includes use of shoulder sling for 6 weeks followed by which physical therapy exercises should be done for 3 months. This helps restore movements and improve strength. You may return to sports only after 5-6 months after surgery.
Patella is the small piece of bone in front of the knee that slides up and down the femoral groove (groove in the femur bone) during bending and stretching movements. The ligaments on the inner and outer sides of patella hold it in the femoral groove and avoid dislocation of patella from the groove. Patellar (knee cap) instability results from one or more dislocations or partial dislocations (subluxations). Patellar dislocation is a condition that occurs when the kneecap or the patella completely shifts out of the groove towards the outside of the knee joint. Normally, the kneecap fits in the groove, but uneven groove can cause the kneecap to slide off resulting in partial or complete dislocation of the kneecap.
Any damage to these ligaments may cause patella to slip out of the groove either partially (subluxation) or completely (dislocation). This misalignment can damage the underlying soft structures such as muscles and ligaments that hold the knee cap in place. Once damaged, these soft structures are unable to keep the patella (knee cap) in position. Repeated subluxation or dislocation makes the knee unstable and the condition is called as knee instability.
Patients with knee instability experience different signs and symptoms such as:
Various factors and conditions may cause patellar instability. Often a combination of factors can cause this abnormal tracking and include the following:
Your surgeon diagnoses the condition by collecting your medical history and physical findings. He may also order certain tests such as X-rays, MRI or CT scans to confirm the diagnosis.
Treatment for instability depends on the severity of condition and based on the diagnostic reports. Initially your surgeon may recommend conservative treatments such as physical therapy, use of braces and orthotics. Pain relieving medications may be prescribed for symptomatic relief. However when these conservative treatments yield unsatisfactory response surgical correction may be recommended.
Considering the type and severity of injury surgeon decides on the surgical correction. A lateral retinacular release may be performed where your surgeon releases, or cuts, the tight ligaments on the lateral side (outside) of the patella enabling the patella to slide more easily in the femoral groove.
Your surgeon may also perform a procedure to realign the quadriceps mechanism by tightening the tendons on the inside or medial side of the knee.
If the misalignment is severe tibial tubercle transfer (TTT) will be performed. This procedure involves the surgeon removing a section of bone where the patellar tendon attaches on the tibia. The bony section is then shifted and properly realigned with the patella and reattached to the tibia with two screws.
Following the surgery rehabilitation program may be recommended for better outcomes and quicker recovery.