Most often they are found in freestyle wrestlers, rugby players, pentathletes, riders, skiers and hockey players. Injured, usually young active athletes.
Symptoms. Feature dislocation acromial end of the clavicle in athletes – a relatively small shift it upwards, due to the conservation clavicular-coracoid ligament, and the presence of powerful muscles.
With a partial dislocation of the clavicle are determined by swelling and pain in the acromioclavicular joint, restriction of movement in the joint. In the diagnosis of the crucial role played by X-ray examination, which is produced in a standing position, when in doubt – simultaneously with the joint health and stress.
Full dislocation clavicle has characteristics: step-strain and clearly palpable under the skin elevated acromial end of the clavicle. In the place of torn ligaments defined swelling, pain, positive symptom "keys."
Treatment. When sprain and partial rupture acromioclavicular junction shown conservative treatment: anesthesia is 1-2% solution of novocaine – 5.10 ml, and then applied retentive bandage type desault with cotton-gauze pelota or elastic belt for a period of 3 weeks. In the axilla should invest tight roll to prevent wrinkling of the shoulder joint capsule and to avoid prolonged contraction. After removing the bandage or sword belt appoint a special set of physical exercises, massage, warm baths and therapeutic classes in the pool. Allowed to proceed to training 4-5 weeks after injury. This treatment gives generally good results.
Gap acromioclavicular joint an indication for surgical treatment. Conservative measures (fixed bus Kozhukeeva, portupeynoy bandage on Salnikov and so on) in this case sometimes do not give the desired result. Since a complete break acromioclavicular joint often accompanied interponirovaniem soft tissue (which in itself is one of the causes of recurrent dislocation), the task is to carefully restore the capsule and ligaments of the joints thick Dacron sutures, complete elimination of the dislocation. It is particularly important retrusion and subsequent transarticular fixation acromial end of the clavicle metal spokes. Now refuse epoletnyh large incisions and small linear incisions are made on the leading edge acromioclavicular articulation (each about 4 cm). Required additional fixation portupeynoy plaster cast for 4 weeks.
When you break the acromioclavicular (Fig. 7, a, b, c) and the coracoid-clavicular ligament operations are applied Bosworht, 1941; Zimmerman, 1970; Dewar – Glorion, 1965-1973; in old dislocations – sometimes the reaction of the lateral part of the clavicle (Mc . Laughlin, Mumford).
Fig. 7. Surgical technique in case of damage acromioclavicular coupling:
and – on Boswort; b – by Zimmermann; in – by Dewar-Morion