ICE-HOCKEY: SHOULDER VS BOARDS
Nineteen years old gentleman presents with pain in his left shoulder since 5 days. Pain began during ice-hockey match, patient was smashed against boards by another player. After the match patient visited traumatology OPD, there were no trauma on the bones on x-ray. Patient was adviced to wear shoulder fixation for three weeks at the traumatology OPD.
The patient came for the second opinion, refered pain (VAS 7/10) when lying on the affected shoulder and when abducting the shoulder over 90°. During clinical evaluation range of motion was not restricted. Scarf test (cross arm adduction test) was positive on the left side. There was also haematoma above AC joint. Jobe’s and Hawkins’ test also positive.
Ultrasound evaluation of the shoulder joint was performed (Figure 1). It revealed effusion of the AC joint on the affected shoulder. There was also slight effusion in the shoulder joint and around biceps tendon, compred to the other side.
Figure 1. Effusion of the left acromioclavicular joint.
Because of the clinical signs and shoulder joint effusion, MRI of the shoulder joint was planned. It revealed subluxation of the AC joint, rupture of AC ligments, CC ligaments were intact.
Diagnosis: Type II acromioclavicular injury, etiology: traumatic.
Mangement: Type II AC injury responds favorably to conservative management. Rehabilitation consists of basic motion and strenghtening excercise. It take 6 to 10 weeks to get fully recovered. For exact rehabilitation protocol week by week you can read this article [1].
Rockwood acromioclavicular injury clssification [2]
Type I – Acromioclavicular (AC) ligament sprain; AC joint intact.
Type II – Acromioclavicular ligament torn, coracoclavicular (CC) ligament intact; AC joint subluxed.
Type III – AC and CC ligaments torn; complete dislocation of the joint.
Type IV – Complete dislocation with posterior displacement of distal clavicle into or through trapezius muscle.
Type V – Superior dislocation of the joint of one to three times the normal spacing, increasing the CC ligament distance two to three times normal.
Type VI – Complete dislocation with inferior displacement of distal clavicle into a subacromial or subcoracoid position.
References
[1] Cote MP, Wojcik KE, Gomlinski G, Mazzocca AD. Rehabilitation of acromioclavicular joint separations: operative and nonoperative considerations. Clin Sports Med. 2010 Apr;29(2):213-28, vii. doi: 10.1016/j.csm.2009.12.002. PMID: 20226315.
[2] Rockwood, CA, Williams, et al. Disorders of the AC join. In: The Shoulder, WB Saunders, Philadelphia 1998. Vol Volume 1, p.483.