WEB PBS JULY 17

BUSINESS SUPPLEMENT
YOU HAVE A BUMP ON YOUR SHOULDER AFTER A FALL. YOU ARE TOLD YOU HAVE
A SHOULDER SEPARATION OR AC JOINT DISLOCATION. NOW WHAT DO YOU DO?
A shoulder separation is an injury to the acromio
clavicular (AC) joint on the top of the shoulder,
where the collarbone (clavicle) meets the highest
point of the shoulder blade (acromion). An
injury to the AC joint is common, often caused
by a blow to the shoulder, or a fall onto an outstretched
hand. The fall injures the ligaments
that surround and stabilize the AC joint, forcing
the clavicle to detach from the acromion. This
creates a bump or bulge above the shoulder.
The shoulder and neck muscles contract a bit
as the shoulder no longer has the strut of the
clavicle to hold it out to length and provide normal
stability.
An AC joint separation is divided into various
categories depending on the severity of the
damage. Mild AC joint injuries (Type I and II)
may respond to conservative treatment such
as ice, a sling and physical therapy. More severe
injuries (Type III, IV, V and VI) are typically
treated with surgery. When these ligaments are
badly torn, they never heal on their own because
the clavicle is elevated past the healing
distance of the torn ligaments.
There remains some controversy about the
best way to treat moderate Type III shoulder separations.
Although some orthopedists choose
the non-operative option, in many cases the
shoulders end up uncomfortable and somewhat
unstable. Athletes who are overhead throwers
or who play tennis, volleyball, and squash,
are significantly weakened by a Type III joint
dislocation for up to a year after injury, and often
mildly affected permanently. Knowing this,
many of our athlete patients choose to have the
injury repaired. The rationale for early repair is
that freshly torn ligaments can be sutured back
together and backed up by wrapping an allograft
tissue around the elevated clavicle.
It is, in our opinion, the safest and strongest
way to rebuild the AC joint with the least complication
rate. Possible complications can be
loss of fixation or loss of stability, which most
commonly occurs when a patient has a repeat
fall during the early healing period.
Another reason to consider repair is that the
long-term outcome of a dislocated AC joint
seems to be painful arthritis at the AC joint
itself, which is somewhat puzzling since the
clavicle is displaced outside the joint. However,
it appears that abnormal forces and motions,
which intermittently cause the clavicle to interact
with the acromion, lead to the degenerative
change over time. The early restoration of the
AC joint may prevent this subsequent AC joint
arthritis.
Many patients take a wait-and-see approach
and then choose to have a late AC joint reconstruction.
The results are also good, but sometimes
not quite as excellent as an early repair,
before the surrounding tissues stretch out.
On the first day, patients can ride a stationary
bike, begin core exercises and scapular stabilization
exercises and obtain a cardiovascular
work out to build a fitness program. Immediate
exercise sends healing endorphins to the torn
tissues, keeps the mind in a good space and
keeps the patient feeling like an athlete in training
rather than a patient in rehabilitation. A
prompt repair and focused rehab can ensure
rapid return to full activities. Significant AC joint
injuries are another example of how conservative
care should mean early repair, not non-operative
care, when the torn tissues can be fixed.
Dr. Watanachai Bangken is an Orthopedic
shoulder specialist at Phyathai Sriracha Hospital
and if you would like to have a consultation
regarding AC joint dislocation or any other
shoulder issues then please contact Phyathai
Sriracha Orthopedic Center on telephone
087 – 100 – 0990 email gavin@phyathai.com
www.phyathai-sriracha.com
Gavin Waddell
Phyathai Sriracha
Hospital
High Tower Co., Ltd. Tel: 038 411 009
For all your advertising enquiries - Tel: 0846 77 43 60