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admin | Category: Ed Treatment For Migraine | 29.12.2015
The SC joint connects your clavicle (collarbone) to your sternum, which is the large bone down the middle of your chest. Like most joints, the SC joint is made up of two bones covered with a material called articular cartilage. It seems like this construction would make SC joint dislocation common, but a dislocation is actually very rare.
The intra-articular disc ligament attaches to the first rib and divides the joint into two separate spaces. A part of the clavicle called the physis does not turn into bone until you are about 25 years old. Direct force against the front of the clavicle can push the end of the clavicle behind the sternum, into the area between the lungs.
Posterior dislocations can be very dangerous, because the area behind the sternum contains vital organs and tissues.
In rare cases, patients have a stable joint but a painful clicking, grating, or popping feeling. Closed reduction involves pulling, pushing, and moving the clavicle until it pops back into joint. After closed reduction for anterior dislocation, your SC joint will need to be held perfectly still.
If your doctor suspects posterior dislocation, you will need to have a complete physical examination right away.
A figure-eight strap is used for at least six weeks after closed reduction for a posterior dislocation of the SC joint.
Sometimes closed reduction for a posterior dislocation does not work, or SC joint problems become chronic. Osteoarthritis of the SC joint usually responds to treatments such as rest, ice, physical or occupational therapy, and anti-inflammatory medications. If you don't need surgery, you should start range-of-motion exercises as pain eases, followed by a program of strengthening.
Some of the exercises you'll do are designed to get your shoulder working in ways that are similar to your work tasks and sport activities. The shoulder joint is incredibly mobile and relies heavily on muscular function for movement, control and stability.
The shoulder is made up of three bones, the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone) as well as associated muscles, ligaments and tendons. The rotator cuff is an anatomical term given to the group of muscles and their tendons that act to stabilize the shoulder.
The shoulder must be mobile enough for the wide range of actions that the arms and hands are capable of, but also stable enough to allow for actions such as lifting, pushing and pulling. Factors Influencing DurationDuration is determined by the grade of AC separation, whether the injury occurred on the dominant or the non-dominant side, and the presence of other injuries.
Disability may be longer for occupations that require manual dexterity, lifting, carrying, throwing, or overhead work. Overview © Reed GroupAcromioclavicular dislocation (more commonly called AC separation) refers to separation of the collarbone (clavicle) from the highest point (acromion) of the shoulder blade (scapula). Dislocation of the AC joint is usually the result of a downward force applied to the acromion (top of the shoulder) from a fall directly onto the shoulder or onto an outstretched arm. This attachment is the only bony joint linking the bones of the arm and shoulder to the main part of the skeleton.
This ligament keeps the sternum end of the clavicle from pointing up as the other end of the clavicle drops down.
The heart and its large vessels, the trachea, the esophagus, and lymph nodes can all be seriously damaged in a posterior dislocation of the SC joint. Dislocation causes severe pain that gets worse with any arm movements.In anterior dislocation, the end of the clavicle juts out near the sternum.
Usually the doctor is suspicious of an injury to the SC joint when there is pain and swelling over the joint. Ice packs can be placed on the sore joint for 15 minutes at a time during the first few days after the injury. When the ligaments are too severely damaged, the clavicle is surgically attached to the rib instead of the sternum. If the symptoms of osteoarthritis do not respond to basic treatment over six to 12 months, surgery may be needed. A resection arthroplasty involves removing the surface of the clavicle next to the sternum.
But if the ligaments are damaged and loose, a tendon graft may be used to tighten the connection between the end of the clavicle and the first rib. Treatments start out with range-of-motion exercises and gradually work into active stretching and strengthening.

Active range-of-motion exercises help you regain shoulder movement using your own muscle power. These exercises focus on improving strength and control of the rotator cuff muscles and the muscles around the shoulder blade. Your therapist will help you find ways to do your tasks that don't put too much stress on your shoulder. Content is the sole property of Medical Multimedia Group, LLC and used herein by permission.
This means that specialised treatment and rehabilitation for a shoulder injury is crucial in returning to your pre-injury state.
It is composed of tendons and muscles (supraspinatus, infraspinatus, teres minor and subscapularis) whose job it is to provide dynamic stability to the shoulder joint throughout all ranges of motion. This compromise between mobility and stability results in a large number of shoulder injuries.
Most patients need reassurance or infrequently, an injection of cortisone to reduce pain in the joint.
Please contact me if you believe that you own any of the images on this website and I can credit the image accordingly. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. These job classifications are based on the amount of physical effort required to perform the work. For non-dominant injuries, individuals may return to work earlier if duties can be performed with one hand.
This injury is often confused with a dislocation of the shoulder (glenohumeral dislocation), which is actually a separation of the bone of the upper arm (humerus) from the socket in the shoulder blade (glenoid cavity of the scapula). In this type of injury, the clavicle remains in place while the scapula is driven down, resulting in a tear to one or more ligament groups in the AC joint capsule. There is limited active range of motion and painful assisted (passive) range of motion of the shoulder.
Dislocating in the opposite direction is less common because the ligaments on the back side of the joint are so strong. It takes a lot of force to cause a posterior dislocation due to the strength of the ligaments behind the joint. Most doctors treat the anterior dislocation by letting it heal where it is or by performing a closed reduction.
Most patients are given general anesthesia before the procedure, or at least some form of muscle relaxant. Your doctor will probably recommend that you take pain medication and wear a figure-eight strap for at least six weeks. It is important that your doctor have as much information as possible about what organs may be affected by the dislocation. The most common type of closed reduction involves lying on your back, with your dislocated joint near the edge of the table. The joint will still probably be unstable, but the displaced clavicle no longer compresses the organs behind the sternum. Surgeons use a piece of tendon taken from the wrist or a piece of fascia taken from the thigh. The program advances to include strength exercises for the rotator cuff and shoulder blade muscles.
The first few therapy treatments will focus on controlling the pain and swelling from surgery. Before your therapy sessions end, your therapist will teach you a number of ways to avoid future problems. The most common shoulder injuries are rotator cuff injuries, bursitis and frozen shoulder (adhesive capsulitis). The major joint of the shoulder is the glenohumeral joint, which is where the humerus attaches to the scapula. Surgery is not often required as the pain often settles with time but can leave a swelling that may be obvious. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles.
Dominant-side injuries may require longer disability, because individuals are not able to use their arm above the waist until healing is complete. The acromioclavicular (AC) joint capsule is made up of several groups of ligaments that stabilize the joint and allow motion. Injuries to the AC joint are graded from I to VI depending on the degree of ligament damage and the resulting separation of the joint.

The cross-body (or crossover) adduction test is the most reliable physical exam technique for AC joint pathology. Historically this was followed by application of a sling or harness (Kenny-Howard sling) to keep the clavicle and acromion in proper alignment. Immediate medical help is required to get the SC joint back into position after a posterior dislocation.
The strap protects the joint from another injury and lets the injured ligaments heal and become strong again. The intense pain and muscle spasms caused by the dislocation can make reduction almost impossible without some form of anesthesia. Posterior dislocation has been known to cause a ruptured esophagus, laceration of major veins, and pressure on major arteries, among other complications.
These occur as a result of two main mechanisms; being macro-trauma (after a tackle on the football field) and repetitive micro-trauma (baseball pitcher or poor computer use).
Grades I and II are more commonly called sprains of the AC joint, incomplete dislocation, or subluxation. Incomplete injuries to the AC joint are 2 to 3 times more common than complete dislocations.
In grade III injuries, the high riding end of the clavicle may be rocked front to back (anterior-posterior) if examined shortly after the injury.
These sorts of traumatic injuries can also cause injuries to the physis in people under 25 years old. If the symptoms last for six to 12 months, some type of surgical treatment may eventually be needed.
In young adults, there is less of this straightening effect because their bone growth is nearly complete. Your physical or occupational therapist will give you tips on controlling your symptoms, which may include using tape to help hold the SC joint in place. Your therapist may also use massage and other types of hands-on treatments to ease muscle spasm and pain. Grade I injuries typically involve stretched or partially torn AC ligaments and joint capsule.
Posterior dislocations can cause difficulty breathing, shortness of breath, or a feeling of choking.
Posterior dislocation has also been known to cause hoarseness, a sudden onset of snoring, and voice changes with arm movement. Grade II injuries are caused by more significant forces, and the AC ligament and joint capsule may rupture. In grades IV through VI, the end of the clavicle may be depressed, aimed behind (posterior), above (superior), or below (inferior) the normal position.
In older individuals, it is important to distinguish AC separation from rotator cuff injuries, impingement syndrome (adhesive capsulitis), and glenohumeral arthritis. Grade III injuries involve tearing of all ligaments, resulting in complete AC joint dislocation. Grades IV through VI also involve a complete dislocation, and may additionally include injury to the surrounding muscles (muscle strains or muscle tears). Individuals complain of pain, tenderness, swelling on the top of the shoulder, and decreased shoulder range-of-motion. Stress radiographs may be used to assess the degree of instability and distinguish grade III separations. The individual holds a weight in the hand on the affected side to show the joint separation more clearly on x-ray (stress radiograph). In rare situations, a computed tomography (CT) or magnetic resonance imaging (MRI) may be needed to evaluate injury to soft tissues surrounding the shoulder. Instability of the joint may cause deformity when the lateral end of the clavicle rises higher than the acromion. Loss of the normal shoulder contour and prominence of the clavicle can be accentuated in grade I and II injuries by having the individual hold a 10 to 15 pound weight in the hand of the affected side.
Early physical therapy (between days 4 and 14 contingent on the amount of pain and swelling) will help the individual regain full range-of-motion. There may be an abrasion on the shoulder as well as swelling and bruising (ecchymosis) at the site of the injury.

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