The collarbone (clavicle) attaches to the roof of the shoulder (acromion) in a joint referred to as the acromioclavicular joint. The collarbone is also stabilized in this area by ligaments called the coracoclavicular ligaments, which attach the collarbone to the front of the shoulder blade (scapula). Direct trauma to this area (such as a football hit or falling over handle bars on a bike) can disrupt these connections and lead to a scenario where the collarbone and roof of the shoulder are no longer sitting next to each other. This is often referred to as an AC separation and leads to elevation of the collarbone that can often be felt at the top of the shoulder.
Mild AC separations can often be treated by rest and sling use followed by a short physical therapy program. However, in cases of a severe separation, surgery is often warranted because chronic shoulder instability and frequent separations and dislocations can occur on a daily basis following the initial injury. Thus, the goal of surgery is to secure the collarbone back into its normal position by attaching very strong sutures to the collarbone and front of the shoulder blade. This is often accompanied by reconstruction of the coracoclavicular ligaments, which involves looping a donated graft from the front of the shoulder blade to the top of the collarbone. Dr. Anz performs this surgery with the use of the arthroscopic camera as well as a small incision at the top of the shoulder.
Following surgery, patients will start shoulder motion under the direction of a therapist. Patients will be asked to wear a sling for protection for many weeks following surgery. Eventually, after the ligaments heal, patients will be allowed to progressively strengthen the shoulder and discard the sling. Return to sporting activities usually occurs around 3 to 4 months after surgery.
For more information on AC joint injuries, or to learn more about arthroscopic AC repair, please contact the office of Dr. Adam Anz, Gulf Breeze, Florida orthopedic shoulder surgeon.