44 y.o. male with a fall onto his left shoulder. Complains of pain in the superior aspect of the left shoulder. He is able to move his arm to some degree but is not able to abduct without pain in the area of the acromion.
Neurovascular exam is intact.
Here is the image of what you see:
A-C separation - likely Grade III since he has significant mobility of the distal clavicle and little pain with movement.
Grades 1-3 are commonly used, though there are rare dislocations of the clavicle that increase the grading system adding levels 4-6. For most purposes, grade 1-3 are sufficient. Grade 1 = partial disruption of the A-C ligament with an intact coraco-clavicular (C-C) ligament. Grade 2 = Complete tear of the A-C ligaments and a partial C-C ligament tear. Grade 3 - complete tears of both the A-C and C-C ligaments.
Not necessarily - treatment of Grade 3 tears is controversial, though grades 4-6 do require repair and replacement of the clavicle.
Grade 1-3 injuries are treated with a sling, ice and pain medication and generally heal with occasional residual pain but good function. X-rays of the shoulder are advisable to insure there is no fracture and to be sure the alignment of the clavicle is favorable for healing (not dislocated- i.e. Grade 4 or above). Weighted X-rays with 10# of weight strapped to the wrist can aid in diagnosis if unclear (with comparison views).
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