AC Separation

Since the ligaments are torn in a grade 2 AC separation, why isn’t surgery the treatment of choice?

One day I was doing stool stepping exercise in my living room. Suddenly, it were as though an unseen force yanked me off the stool while I had one foot on it and threw me to the floor.

It was over in a split second; too quickly for my athletic body to react. I landed on my shoulder and it hurt like hell.

I diagnosed myself with a possible AC separation, either a grade 1 or 2.

Separation of the acromioclavicular joint is usually caused by falling on one’s shoulder — which can happen after falling from a height or being tossed from a bicycle or skateboard.

A more serious injury (higher grade) may occur from a vehicular accident.

In a grade 2 AC separation, ligaments are torn from the bone.

Now in the case of an ankle injury in which ligaments are severed, surgery is the standard treatment. Same with the ligaments in the knee.

So I wondered why, in the case of a grade 2 AC injury, surgery isn’t performed.

For this article I interviewed Jonathan Oheb, MD, North Valley Orthopedic Institute, Chief of Orthopedic Hand and Upper Extremity Surgery; jonathanohebmd.com.

Dr. Oheb explains, “It is not recommended because it has not been shown to significantly improve the average person’s long-term function.

“However, with a high demand patient who continues to have symptoms after a course of conservative treatment, surgery would then be an option.”

In my case, the injury turned out to be a hairline fracture of the clavicle. The symptoms were identical to that of a grade 1 or 2 AC joint trauma save for a visible deformity. It healed beautifully with patience.

Standard Treatment for a Grade 2 AC Joint Injury

  • Rest from activity
  • Use of a sling
  • Cold packs
  • Painkillers
  • Physical therapy

The above protocol works superbly; surgery is not required unless the injury is really severe.

Prevention of an AC joint separation is not related to physical fitness. It’s related to activity. Be extra careful when you’re involved in activity that has the potential to cause a fall.

In addition to hand, elbow and shoulder care, Dr. Oheb provides comprehensive surgical and nonsurgical treatment for all orthopedic conditions of the hip, knee and ankle, including broken bones and injuries.