tonyte8008’s BodyBlog

Tonight was my partner and i’s first night doing squats in about 5 months. We had shoulder injuries that prevented us from doing them. After tonights leg workout including squats, all i can say is ouch and wow. My legs are sore already, it’s true what they say about squats, they are one of the best lifts in the weight room!

What does everyone else think?

Ok, so i know that this is pretty lame for me being 20 yrs old and all, but you’ll understand when i get finished.

My partner and I both agree that we wish we could fast-forward through the weekends so we can start another week of lifting. Don’t get me wrong, i like hagin out with the friends on the weekends and all, but where i live theres basically nothing at all to do. and if there is something you can bet that you’ve done it so many times that it gets boring.

So thats basically why we look foreward to every week in the gym it’s basically our biggest hobby since neither of us is training for a sport anymore, we lift to lift. we somehow stay motivated just with that.

In the next three month’s i would like to be doing or close to doing these things.

1. Most of all i would like to be able to start doing flat bench again. since the a/c injury i haven’t even been able to attempt to bench press and this is my favorite lift so it’s not fun.

2. I would also like to be squating at least 350. I know that this realy doesn’t sound like much for a person my size, but i never really paid attention to squat in highschool and we i actually started lifting serious i was embarassed because i could pretty much keep up with my partner in everything but squat, i wasn’t even close and that got to me. so besides taking care of my shoulder squat is the thing i would like to work on most.

3. cardio, what else needs to said. i never had a problem getting enough cardio when i played football, but since then i have hard a hard time sticking with it. it’s just something about not being outside while im running. I can’t stand treadmills.

4.Bodyfat %. im not real sure what mine is right now but i know i would like to have it under 10 %.

5. lastly,even though it has nothing to do with the gym, be a better person and live life to the fullest.

These are my goals for the next three months. I’ll try to keep you updated on there progress.

Acromioclavicular Joint Injury

Article Last Updated: Oct 26, 2006

AUTHOR AND EDITOR INFORMATION

Author: L Edward Seade, MD, Consulting Staff, Orthopaedic Specialists of Austin

Coauthor(s): William Jay Bryan, MD, Clinical Professor, Department of Orthopedic Surgery, Baylor University College of Medicine; Reed L Bartz, MD, Consulting Staff, Division of Sports Medicine, Nebraska Orthopaedic and Sports Medicine PC; Robert Josey, MD, Consulting Staff, Department of Orthopedic Surgery, Orthopaedic Specialists of Austin

Editors: David T Bernhardt, MD, Director of Adolescent and Sports Medicine Fellowship, Associate Professor, Department of Pediatrics, University of Wisconsin; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Russell D White, MD, Professor of Medicine, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood; Jon Whitehurst, MD, Consulting Staff, Rockford Orthopedic Associates; Craig C Young, MD, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical College of Wisconsin

Author and Editor Disclosure

Synonyms and related keywords: acromioclavicular joint injury, shoulder separation, shoulder dislocation, shoulder pain, AC joint injury, AC separation, AC joint disruption, acromioclavicular disruption

Injuries in and around the shoulder are common in today’s athletic society. Proper knowledge of the different problems and treatment options is necessary to get patients back to their preinjury state.

Background

Acromioclavicular (AC) joint injuries are common and often seen after bicycle wrecks, contact sports, and car accidents. The AC joint is located at the top of the shoulder where the acromion process and the clavicle meet to form a joint. Several ligaments surround this joint and depending on the severity of the injury, a person may tear one or all of the ligaments. Torn ligaments lead to AC joint sprains and separations. The distal clavicle and acromion process can also be fractured. Injury to the AC joint may injure the cartilage within the joint and can later cause arthritis of the AC joint. This article discusses the anatomy of the joint, the diagnosis of this condition, and the different treatment options.

Frequency

United States

Injuries to the AC joint are the most common reason that athletes seek medical attention following an acute shoulder injury. Glenohumeral dislocations (see Shoulder Dislocation) are the second most common injuries seen. Men in their second through fourth decades of life have the greatest frequency of AC joint injuries. These injuries are most often incomplete tears of the ligaments.

Functional Anatomy

The AC joint is made up of 2 bones (the clavicle and the acromion), 4 ligaments, and a meniscus inside the joint.

• The AC joint is surrounded by a thin joint capsule and 4 small ligaments. These ligaments mostly give joint stability to anterior and posterior translation. They provide the horizontal stability to the joint.
• Another set of ligaments also provides vertical stability to the AC joint. These ligaments are called the coracoclavicular (CC) ligaments. The CC ligaments are found medial to the AC joint and go from the coracoid process on the scapula to the clavicle.
• Different injuries result in different tears of the 2 CC ligaments (the conoid and the trapezoid). Torn AC joint ligaments and/or torn CC ligaments are seen in AC joint sprains. The meniscus that lies in the joint may also be injured during sprains or fractures around the AC joint.

Sport Specific Biomechanics

When a person falls onto their shoulder, the force pushes the tip of the shoulder down. The clavicle is usually kept in its anatomic position while the shoulder is driven down, which injures the different ligaments or causes a fracture. When the ligaments are injured they are either sprained or, in more severe cases, torn.

AC joint sprains have been classified according to their severity. In a type I sprain, a mild force applied to these ligaments does not tear them. The injury simply results in a sprain, which hurts, but the shoulder does not show any gross evidence of an AC joint dislocation. Type II sprains are seen when a heavier force is applied to the shoulder, disrupting the AC ligaments but leaving the CC ligaments intact. When these injuries occur, the lateral clavicle becomes a little more prominent. In type III sprains, the force completely disrupts the AC and CC ligaments. This leads to complete separation of the clavicle and obvious changes in appearance. The lateral clavicle is very prominent. A few more types of AC joint sprains have been classified, but types I - III are the most common.

Classification of acromioclavicular (AC) joint injuries.

An AC joint sprain is more common than a fracture after an injury. However, fractures of the distal clavicle and the acromion process may occur, so the health care provider must be aware of such injuries and ready to diagnose and treat them as well (see Clavicular Injuries).

History

Acromioclavicular (AC) joint injury should be considered in any patient complaining of pain over the superior part of the shoulder. Injuries to this part of the body are painful.

• The most common mechanism for an AC joint injury is a fall directly onto the acromion with the arm adducted up against the body. Multiple indirect forces can result in an AC joint injury. A fall onto an outstretched hand and a downward force on the upper extremity have been implicated in AC joint injuries.
• In the immediate setting, the patient may initially experience generalized shoulder tenderness and swelling; however, as the diffuse pain resolves, specific point tenderness over the AC joint is usually noted. The athlete may note a significant abrasion or prominence of the distal clavicle.
• Athletes involved in weight training typically experience pain with specific exercises such as bench press and dips.
• Many individuals experience nocturnal pain and awakening when rolling onto the involved shoulder. Rolling onto the shoulder puts pressure on the AC joint.
• Rarely, the patient may report popping or catching in the region of the AC joint.

Physical

• Patients have pain over the AC joint. Swelling, bruising, and a prominent clavicle may be evident, depending on the type of sprain that the patient has sustained. In types I and II, deformity is usually minimal. In type III, the distal clavicle is abnormally prominent. Of note, clavicle fractures, without AC joint sprains, can also cause the clavicle to be prominent.
• The patient has poor shoulder range of motion and moderate pain when trying to raise up the arm.
• In the acute situation, the examiner may have difficulty ruling out a concomitant rotator cuff tear as active and passive shoulder abduction maneuvers are difficult to perform in the face of an AC joint separation.
• The most reliable physical examination test for AC joint pathology is the cross-body adduction test. The test is performed by elevating the arm on the affected side 90º while the examiner grasps the elbow and adducts the involved arm across the body. Although reproduction of pain with this maneuver may occur in patients with posterior capsule tightness or subacromial impingement, pain is suggestive of AC joint pathology. Restriction of range of motion, which is rarely associated with AC joint pathology, more likely suggests adhesive capsulitis or glenohumeral arthritis.

Causes

Other Problems to be Considered 

Glenoid labrum tear

Imaging Studies

• Radiographs
  • As with all skeletal injuries, a minimum of 2 views is necessary to evaluate the individual injury.
    • Anteroposterior (AP) and lateral views are the minimum needed to evaluate an acromioclavicular (AC) joint injury. The AP view should be taken with the arms at the side, and both AC joints should be imaged for comparison. If a true AP view is obtained, the AC joint can be seen superimposed on the spine of the scapula; hence, some authorities have recommended the Zanca view, in which 10-15° of cephalic tilt of the radiographic beam provides a clearer image of the AC joint.
    • An axillary lateral view is also needed in suspected AC joint injuries to account for any anterior or posterior displacement of the distal clavicle.
      Type III AC joint separation.
  • If an unstable AC joint injury is suspected, yet not confirmed on routine AP and lateral views, stress views may be indicated.
    • Ten to 15 lb of weight should be attached to the wrist of the affected side, and an AP view can be taken. This stress tests the integrity of the coracoclavicular (CC) ligament, and, if the ligament has been disrupted completely, the test will demonstrate the complete dislocation.
    • Routine use of stress radiographs is not recommended in the emergency department setting because of the painful nature of the test. Weighted stress tests may be valuable in follow-up care if the clinician has any doubt about the instability of the AC joint. Even with conservative care of types III-VI AC disruptions, this test may be helpful for determining a timetable for return to conditioning and sporting activities.
       
  • Athletes with a prior history of AC injury or a history of heavy weight lifting may present with relatively acute shoulder pain over the distal clavicle and may have classic radiographic findings of distal clavicle osteolysis or AC osteoarthritis (ie, joint narrowing, distal clavicle or acromial spurring). When these radiographic findings are present, the clinician may expect that seemingly little trauma may result in significant pain.
• MRI
  • MRI is not ordered routinely in the management of straightforward AC disruptions. Detailed knowledge of AC and CC ligamentous injury is not needed for conservative or, in rare cases, surgical care.
  • In middle-aged and older patients who continue to have disabling shoulder pain after the acute pain of an AC disruption abates, one may consider an MRI to evaluate for a possible rotator cuff tear.
  • Very rarely, athletes with persistent pain over the AC joint merit an MRI to determine whether or not the cartilaginous disk has been damaged irreversibly and determine whether or not the process of distal clavicle osteolysis or early osteoarthritis has begun.

Acute Phase

Rehabilitation Program

Physical Therapy

Acromioclavicular (AC) joint injuries are painful and the patient often lacks full range of motion after the injury. Physical therapy plays a role in the treatment of these patients. The author routinely starts therapy within the first couple of weeks in AC joint sprains. For fractures, wait until evidence of healing is apparent either clinically or on radiograph before starting formal therapy. Therapy for degenerative joint disease of the AC joint has not been proven successful.