Diagnosis: The x-ray shows a type III acromioclavicular joint separation with disruption of the acromioclavicular and coracoclavicular ligaments, a complete tear of the AC joint.
Coracoclavicular ligament disruption is noted by the elevation of the distal clavicle. AC disruption is represented by a widening of the AC joint space.
An axillary view of the shoulder is necessary in all type III injuries to rule out a type IV (unstable) injury. This would show posterior displacement of the clavicle and requires immediate referral to an orthopedist.
Type III joint injuries are most often managed non-operatively with rest, ice, sling, and analgesics, as was the case with this patient.
This patient was placed in a “Vietnam” sling and referred to his HMO for follow-up.
Case presented by Nahum Kovalski, BSc, MDCM.
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