Standardized ultrasound examination for evaluation of instability of the acromioclavicular joint

Abstract

Anteroposterior X-ray views of both acromioclavicular (AC) joints with 10-kg weights held in each hand are the generally accepted procedure for diagnosis of Tossy I-III grades of AC joint separation. An analogous diagnosis can be made by standardized ultrasound examination. Ten individuals with Tossy-I, 11 with Tossy-II and 8 with Tossy-III instability were examined both radiographically and by B-mode ultrasound. The degree of AC joint separation was uniformly determined on the basis of a calculated index (AC Index = AC joint width of uninjured side/AC joint width of injured side). The mean AC Index for Tossy-I instability determined by ultrasound was 1.0; mean indices of 0.49 and 0.5 were determined for Tossy-II injury by ultrasound and X-ray, respectively, and of 0.21 and 0.2, respectively, for Tossy-III instability. Statistical analysis showed significant differences between the mean AC indices of all three groups (P < 0.0001). We conclude that the reliability of ultrasound examination of AC joint instability is equal to that of radiographic measurement. Standard X-rays of the shoulder remain mandatory only to exclude fracture. The indication for operative stabilization of the AC joint can be established on the basis of the grade of AC joint instability measured by the side-effect-free and cost-effective method of ultrasound examination (AC Index < 0.3 equivalent to Tossy-III instability).

Comprehensive Shoulder US Examination: A Standardized Approach with Multimodality Correlation for Common Shoulder Disease

“…In addition, although US is not primarily used in the setting of trauma, it is more sensitive than radiography for the identification of grade I AC joint injuries, which appear as softtissue swelling and capsular distension on US images. The US findings of more severe traumatic AC joint injuries are similar to the radiographic findings (Fig 9) (27,29,30).…”

“…The elbow should then be bent and crossed over the chest, with the hand touching the opposite shoulder. Stress imaging with the patient holding weights-akin to stress radiographic examinations-has also been described (29).…”

Sonographic Examination of the Acromioclavicular and Sternoclavicular Joints

“…Because the anterior aspect of the AC joint is wider than the posterior aspect, separation may be overestimated if the corresponding region of the asymptomatic contralateral AC joint is not assessed for comparison. 12 …”

Die Stabilisierung des luxierten Schultereckgelenks mit Bandnaht und Balser-Platte

“…Zwischen 7/98 und 9/99 wurden 57 (83,8%) Patienten durchschnittlich 24,6 (12-49) Monate nach Implantatentfernung hinsichtlich des funktionellen Befunds, der Position des Akromioklavikulargelenks mittels Sonographie [3] mit und ohne 10 kg Belastung [12] sowie des subjektiven Beschwerdebildes nachuntersucht [22]. Die subjektive Bewertung erfolgte anhand eines 18 Punkte umfassenden Fragebogens, der zusammen mit den Ergebnissen der klinischen Untersuchung und der Sonographie in einen eigenen Bewertungsscore eingearbeitet wurde [5].…”