Acromioclavicular joint disorders treatments
When is surgical treatment necessary for a sprained acromioclavicular joint?
Surgery is almost never required. The most common types (I and II) of this condition, although very painful during the first few weeks, respond very well to conservative treatment.
- Early mobilization
Grade III sprain is the intermediate stage and refers to a complete separation of the clavicle and the acromion as well as ptosis of the entire upper limb. While this prospect might seem dreadful, once the aesthetic deformity is accepted, normal function is almost fully restored, as many professional hockey and football players will confirm. Surgical repair is reserved for certain grade III cases in people who practice high-level activities requiring full elevation of the arm (e.g., professional tennis players) or for very rare (extreme) grade IV, V and VI cases.
Conservative treatment, like physiotherapy, can be attempted first for 2 to 3 months in the case of Grade III sprains sustained in impact sports (American and Canadian football, rugby, hockey); later reconstructive surgery will only be considered for patients who were unable to resume their pre-injury sport.
Why not operate on all Grade III cases?
Two reasons: as mentioned earlier, normal function is almost fully restored without surgery; and because surgery carries inherent risks of complications and the need for subsequent surgery (more than 50% of the time!). We see no need to complicate things when we can keep it simple.
Surgery for osteoarthritis of the acromioclavicular joint (excision of a 1 cm portion of the distal clavicle)
In advanced osteoarthritis, the cartilage covering the distal clavicle gradually wears away until it disappears completely, allowing the exposed bone to come into direct contact with the acromion and causing pain. The purpose of resection is to create enough space to prevent bone-on-bone contact, which increases when the arm is crossed over the chest. The newly created space then fills with painless fibrous scar tissue. Bone spurs (osteophytes), which often form over the years, filling the space over the rotator cuff and causing mechanical impingement, are also excised. This procedure can be performed arthroscopically, either alone or in combination with acromioplasty.
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Five months after my operation, despite the severity of my wound, I am again able to ride a bike without difficulty or pain. I had an impeccable and attentive follow-up from Dr. Beauchamp. Thank you!