1. Acromioclavicular Dysfunction

2. Normal Anatomy The joint is made stable of the acromioclavicular ligaments, joint capsule and coracoclavicular ligaments The acromioclavicular ligaments superiorly and inferiorly stabilise smaller movements of the ACJ The coracoclavicular ligaments stabilise larger movements of the ACJ

3. Coracoclavicular Ligament

4. Pathology Injury to the acromioclavicular joint and the surrounding soft tissue

5. Mechanism Of Injury Falling onto shoulder with arm in adducted position Direct blow to acromioclavicular joint Falling on outstretched arm or onto elbow

6. Classification

9. Associated Pathologies Intra Articular Glenohumeral Joint damage Neurovascular compromise

10. Subjective 30+ Direct blow to lateral acromion Falling on shoulder with arm in adducted position Falling on outstretched arm or onto elbow Usually part of a sporting incident

11. Objective Supports elbow Step Deformity IR, Horizontal adduction and Elevation Tenderness ACJ

12. Special Tests Horizontal adduction O’Brien’s Test Palpation

13. Further Investigation X-ray Injection

14. Conservative - Management Type I – III Sling initially for pain relief only Discontinue as soon as pain allows Avoid end range elevation, horizontal adduction and IR (Hand behind back) in early stages Focus on scapular stabilisation

15. Conservative - Management Restore Normal Mobility 1.Decrease Swelling 2.Normalise Surrounding Soft Tissue 3.Restore Normal Joint Mechanics Restore Normal Stability 1.Motor Control and Strength Scapular Stabilisers 2.Proprioceptive Training 3.Return to Sport/Activity Specific Exercises

16. Management – Plan B Corticosteroid Injections Types IV, V and VI – Surgery – Reduced the instability – Tendon graft reconstruction of coracoclavicular or acromioclavicular ligaments