How to tape the AC joint. A detailed look at my successful rehab protocol for a grade 3 ac joint (Acromioclavicular) separation. A type III separation involves injury to both the AC joint ligaments the CC ligaments. Same injury from motocross in 2008. Sling should be in place for 5-7 days when not performing exercises. Grade 3 AC Joint Separation Now when it starts getting tricky is when you have involvement of all three ligaments here, so you have a tear here, a tear here, and a tear here [pointing to the three ligaments surrounding the joint]. AC Separations are a relatively common cause of shoulder pain and deformity. Mild vertical separation (normal AC interval 5-8 mm) Type 3. Diagnosis: R / L Grade (1/2/3) AC Separation Frequency: 2-3 times per week for 6-12 weeks, therapy to start immediately after injury *VERY IMPORTANT: THERAPIST MUST OBSERVE ATHLETE DURING EXERCISES TO MAINTAIN SCAPULAR RETRACTION AT ALL TIMES DURING THERAPY* Weeks 0-3 Therapist to observe athlete during rehab for proper mechanics Grade 5 AC Separation A grade 5 AC Joint Separation occurs when the clavicle is severely displaced superiorly. may be the only finding in type I injuries. Type 4. clavicle displaced cephalad by one-half the depth of the AC joint. The initial symptoms are very severe pain, localized swelling and the notable presence of a bump on the shoulder. Taken September 6, 1999. Classification of AC Joint Separation - Rockwood Classification, 1990 4, 6 Type I o Mild sprain of the AC ligament o No disruption of AC or coracoclavicular ligaments (Grade II or III) with loss of normal contour of the shoulder due to sagging of the acromion indicates ligamentous disruption of the AC joint.1, 6 An acromioclavicular joint separation, or AC separation, is a very frequent injury among physically active people.In this injury the clavicle (collar bone) separates from the scapula (shoulder blade). Grade 3 AC Joint Shoulder Separation. What is the treatment for AC joint separation? These can be very painful injuries and the initial treatment is to decrease the pain. This is best accomplished by immobilizing the arm in a sling, placing an ice pack to the shoulder for 20 to 30 minutes as often as every two hours and using pain medication. In a grade 3 AC joint sprain, the ligaments holding the joint are completely torn, making your shoulder highly unstable. Due to normal appearing x-ray, you diagnose the patient with a Grade II AC joint separation (due to the clavicle mobility on exam). https://www.acjointseparation.com/grade-3-ac-separation-surgery-or-not In a grade II injury these ligaments are only stretched but not entirely torn. Distal clavicle positioned posterior to acromion. Grade 3: The most severe shoulder separation completely tears both your AC and CC ligaments and puts your shoulder joint noticeably out of position. CC distance 25-100% of contralateral side. Grade 3 AC joint separation is a complete separation of the joint where the AC ligament and CC ligaments are completely torn, as well as the joint capsule. A separated shoulder is when the ligament connection between the collar bone and the shoulder blade becomes injured. One study found that surgery may actually be no better than conservative management, even for high-grade shoulder . Recommendations are 3: 2-4 weeks for Grade I injuries; 4-6 weeks for Grade II injuries; 6-12 weeks for Grade III injuries; Case conclusion. Ligaments are tough, sinewy tissues that act like tethers to hold the bones together. I go through the exercises I did, the timing of progress and the supporting strategies to ensure my early return to hard climbing. If the distance between the two bones is at least 25% increased relative to the normal side, but less than 100% (double the distance) then the injury is considered to be a grade 3. This is also called a sprain. The initial symptoms are very severe pain, localized swelling and the notable presence of a bump on the shoulder. A grade 3 AC joint separation is a complete separation of the joint where the AC ligament and CC ligaments are completely torn, as well as the joint capsule. Scapular rhythm. Grades 4, 5 and 6 AC separations are extremely rare. Grade 4 involves posterior displacement or displacement backward. normal: 5-8 mm (narrower in the elderly) greater than 2-4 mm asymmetry (compared to radiographs of the contralateral side) A grade 3 is the worst and a grade 1 is the least severe. There are three basic types of AC Joint Sprains: Grade 1, Grade 2 and Grade 3. A grade 3 AC joint separation is a true dislocation of the AC joint. Grade III- The most severe shoulder separation. This completely tears both the AC and CC ligaments and puts the AC joint noticeably out of position, with a larger bump. SEPARATED SHOULDER SYMPTOMS Swelling, tenderness, or pain over/above the joint Visible bump above the shoulder Loss of strength or motion Pain when lying on ones side COuld be done at any time so no rush. 3. In the Williams and Rockwood classification a Grade III separation is described as a superior displacement of the clavicle and a 20% to 100 Only nine studies met the inclusion criteria of comparing the results of nonoperative treatment of Grade III AC joint separations to various forms of operative stabilization. (Color version of figure is available online.) Grade 3 rupture of both AC and CC or coracoclavicular ligaments which often results in an upward displacement of the clavicle bone. Video Discussion. Type 5. An AC Separation, also called a Shoulder Separation is a different injury then a Shoulder Dislocation. What is an AC joint separation? The shoulder blade and upper arm bone should move together with the correct timing. Grade I- mild shoulder separation. If the distance is more than that it is a grade 5. Also grade 3, surgery was optional and I declined. Grade 3 injuries are more frequently treated conservatively, without surgery, but will require an even longer rest/healing period. 3 GRADES OF SEPARATED SHOULDER. Initiate exercise program 3 times per day: If you have displacement, thats considered a Grade 3 separation or AC joint separation. I'm a 27yr old male, 210lbs. What is a Grade 5 AC separation? I've had a 3rd degree shoulder separation on my right shoulder when I was 16, even after the surgery and recovery, it would separate frequently, but it hasn't separated since I was about 24. (see photo normal and sprain labeled with arrows). I had a severe (grade 3) AC joint separation in 2017. Even the grade 3 injuries usually allow a return to full activity with few restrictions. In contrast, high grade injuries (Type IV, V, and VI) involve injury to the AC joint, coracoclavicular (CC) ligaments, and overlying fascia and should thus be managed surgically. How painful is a grade 3 AC joint sprain or separation? I think the procedures now are better so I might choose differently now. Types of AC joint injuriesType I = the AC ligament is slightly torn, but there's no damage to the CC ligament is unharmed.Type II = the AC ligament is completely torn, and there's little or no tear to the CC ligament.Type III = both the AC and CC ligaments are completely torn. In this case, the collarbone separates from the end of the shoulder blade. Grade 3 AC joint sprain. An acromioclavicular joint injury, otherwise known as a shoulder separation, is a traumatic injury to the acromioclavicular (AC) joint with disruption of the acromioclavicular ligaments and/or coracoclavicular (CC) ligaments. A careful and precise x-ray evaluation is critical in diagnosing the correct ac joint separation grade. AC and CC disrupted. CC distance >100% contralateral side. It is commonly caused by a strong force hitting the shoulder, such as a direct blow from an external force or directly falling on the shoulder. They were telling me 6+ months before I could lift any weight after the type of surgery they did back then. Twenty-eight major league baseball (MLB) orthopedic team physicians were surveyed to determine their definitive management of a grade III AC separation in the dominant arm of a professional baseball pitcher and their experience treating AC joint separations in starting pitchers and position players. The AC joint may also become swollen, the upper extremity often held in adduction with the acromion depressed, which may cause the clavicle to be elevated. A grade 3 AC joint separation is a true dislocation of the AC joint. Symptoms range from mild tenderness felt over the joint after a ligament sprain to the intense pain of a complete separation. Non-operative Acromioclavicular Joint Separation Phase I: Gradual ROM (Injury to 2 weeks) Ice encouraged for the first week at a minimum: should be used 3-4 times per day. This involves a sprain of the AC ligament that does not move the collarbone and looks normal on X-rays. Allman et al described a 3 grade classification with Rockwood and Green expanding this to a 6 grade classification model (known as the Rockwood grades). I recently separated my shoulder and I looked on youtube to see how other people coped with the injury. Features of acromioclavicular joint injury include 6: soft tissue swelling/stranding. Grade II a tear in the AC ligament, and/or a sprain or slight tear in the coracoclavicular (CC) ligament. A grade 3 AC joint separation is a true dislocation of the AC joint. As the shoulder strikes the ground, the force from the fall pushes the scapula down. Ortho said surgery was an option but recommended against it at the time. Grade 5. This will provide an anchor for the support strip to attach to. Diagnosis is made with bilateral focused shoulder radiographs to assess for AC and CC interval widening. Acromioclavicular (AC) joint injuries account for nearly half of all shoulder injuries among athletes involved in contact sports [13].While most injuries can be managed non-operatively, high-grade separations may result in persistent pain or functional decline and require surgical intervention [49].Many surgical techniques have been described However, any direct blunt force can cause an AC joint separation if severe enough. The patient was diagnosed with a right-sided incomplete grade III AC joint separation with associated soft tissue swelling, ecchymosis, and loss of AROM. X-rays show one-half separation of the AC joint, i.e. Exercises to restore the scapular rhythm are also important. The Traditional Grade III, Severe AC Joint injury would equal "Superior Dislocation of the AC Joint (>100% but <200% displacement of the We have a patient who had a diagnosis of "right shoulder separation, acromioclavicular joint grade II". AC joint separation symptoms vary based on the extent of injury. Next pass a support strip of tape from the front of the shoulder, down the side of the arm applying tension to the tape. Currently with regard to the common subtypes of complete AC joint separation (grades 3, 4, and 5) there is AC separations cause significant pain on the top of your shoulder. Grade 3 AC Joint Separation: Physical Therapy Protocol Immediate intervention for grade 3 AC joint injury involves the same treatments as grade 1 and 2 joint separation. While higher grade dislocations (grade 4, grade 5, and grade 6) are more severe they only differ from a grade 3 by the severity and the direction of the displacement. Many different procedures, not all off them work, some not very well, long recovery time and trading a scar for a bump. First, apply two or three strips of 2.5cm zinc oxide tape over the top of the shoulder covering the AC joint. The patient is provided analgesia and placed in a sling for comfort. Doc says it is a grade III ac separation. widening of the acromioclavicular joint. What You Need to KnowThe most common conditions of the acromioclavicular joint are arthritis, fractures and separations.Acromioclavicular joint wear and tear is common among weight lifters.Treatment for AC joint problems ranges from non-operative to surgical procedures depending on the type of injury. Grade 3 AC Joint Separation: Physical Therapy Protocol Immediate intervention for grade 3 AC joint injury involves the same treatments as grade 1 and 2 joint separation. The most common cause of an AC joint separation is falling on the shoulder. Feb 2008 full grade III separation. When the AC joint is separated, it means that the ligaments are torn and the collarbone no longer lines up with the acromion. Minor injury (Grade 1 or 2) If the AC joint is sprained but not dislocated the x-ray will be normal or nearly normal. Acromioclavicular joint (ACJ) separations make up approximately 9% of all injuries to the shoulder girdle in sports medicine and orthopedic practices. However, any direct blunt force can cause an AC joint separation if severe enough. Sep 20, 2020. Diagnosis. Most AC separations occur from a hard fall onto the point of your shoulder. An AC joint injury will either be a minor injury (grade 1 or grade 2), or a major injury (grade 3, grade 4, or grade 5). Introduction. Grade I Injury the least damage is done, and the AC joint still lines up. Grade II Injury damage to the ligaments which reinforce the AC joint. Recovery from a Grade I AC separation usually takes 10 to 14 days, whereas a Grade III may take six to eight weeks. There is considerable debate, however, about type III injuries. It is commonly caused by a fall directly on the "point" of the shoulder or a direct blow received in a contact sport. Return-to-play outcomes were also evaluated. Grade 3: Complete AC joint separation more than one-half the depth of the AC joint; clavicle under skin. Coraco-clavicular distance increased as compared to normal side with partial tear of coraco-clavicular ligaments. The diagnosis of a grade III AC joint separation. Grade 4 AC joint sprain. Subcutaneous distal clavicle. Subject: RE: Grade 3 AC joint separation - surgery?