A Prospective Evaluation of Untreated Acute Grade III Acromioclavicular Separations

Abstract

We prospectively studied the natural history of untreated acute grade III acromioclavicular separations. Twenty-five patients were treated nonoperatively with a sling for comfort through progressive early range of motion as tolerated. Ten additional uninjured subjects underwent strength testing to evaluate the difference between the dominant and nondominant sides so that patient data could be standardized. The patients were examined at intervals of 6, 12, 24, 36, and 52 weeks after injury, at which time they completed a subjective questionnaire and underwent isometric dynamometer testing as well as military press and bench press strength testing. One patient underwent a surgical procedure at 2 weeks after injury because of cosmetic concerns. Twenty of the 25 patients completed the 1-year evaluation and strength-testing protocol. Subjectively, 4 of the 20 patients (20%) thought that their long-term outcome was suboptimal, although for 3 of them it was not enough to warrant surgery. Objective examination and strength testing of the 20 patients revealed no limitation of shoulder motion in the injured extremity and no difference between sides in rotational shoulder muscle strength. The bench press was the only strength test that showed a significant short-term difference, with the injured extremity being an average of 17% weaker. This study documents the natural history of patients with an untreated acute grade III acromioclavicular separation and provides a reference with which to judge all other proposed methods of treatment.

Acromioclavicular joint injuries: indications for treatment and treatment options

“…35 Return to sports should be delayed until full, painless range of motion is obtained, which may require 3 months. Schlegel et al 78 showed favorable outcomes in 80% of their patients after nonoperative treatment at 1 year of follow-up, and others have found similar success with up to 5 years of follow-up. 26,92 Functional deficits are minimal, with the objective evaluation of shoulder strength reported to be similar to that of the contralateral shoulder at midterm follow-up.…”

Managing and recognizing complications after treatment of acromioclavicular joint repair or reconstruction

“…Management of type III injuries remains controversial. While nonoperative treatment can be successful, studies have shown that residual functional deficits may persist, including scapulothoracic dyskinesis, which may require further therapeutic intervention [11,12].…”

Conservative management of a type III acromioclavicular separation: a case report and 10-year follow-up

“…Schlegel et al 16 prospectively investigated the natural history of type III AC separations when given a sling for up to 2 weeks, course of early ROM, and pain medication among 20 active subjects. The authors concluded that, at 1-year follow-up, 80% of the cases had a satisfactory result, 14 of 16 subjects did not experience pain related to the injury when engaging in strenuous physical activity, and only 3 subjects reported weakness with overhead activities and bench press activities if done in a repetitious fashion; 88% reported a residual deformity.…”