Two patients present to your emergency department: Patient 1 is a 17 year-old soccer player who fell during a game onto their right side and is now complaining of mild right shoulder pain. You obtain x-rays (Figure 1). Patient 2 is a 21 year-old motorist who lost control and went over the handlebars. They heard a pop and are complaining of left shoulder pain. You obtain shoulder x-rays (Figure 2). For these cases, what are your diagnoses, expected physical examination findings, and emergency department management?
For more information about acromioclavicular separations, University of Washington has a great AC joint reference and Orthobullet’s review of acromioclavicular separations is also worth checking out. Want more SplintER?
For more cases like these, you can subscribe to the Ortho EM Pearls email series hosted by Drs. Will Denq, Tabitha Ford, and Megan French, who have kindly shared some of their content with ALiEM.
References:
- Vanhoenacker F, Maas M, Gielen JL. Imaging of Orthopedic Sports Injuries. Springer Verlag. (2006) ISBN:3540260145
- Kiel J, Kaiser K. Acromioclavicular Joint Injury. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2019 jan. PMID: 29630240
- Ibrahim ef, Forrest NP, Forester A. Bilateral weighted radiographs are required for accurate classification of acromioclavicular separation: An observational study of 59 cases. Injury Int J Care Injured 46(2015)1900-1905. PMID: 26194267
- Stapczynski, J S, and Judith E. Tintinalli. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8th Edition. New York: McGraw-Hill Education, 2016. ISBN: 9780071794763
- Favorito, PJ., Herbst., KA., Acromioclavicular joint injuries, Shoulder and Elbow Trauma and its Complications., Woodhead Publishing Series in Biomaterials., Volume 1., Pages 215-231., 2015. ISBN: 9781782424727