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Dislocation, Acromioclavicular Joint

Differential Diagnoses

Acute traumatic bursitis
Adhesive capsulitis
Clavicle fracture
Glenohumeral arthritis
Glenohumeral shoulder dislocation
Impingement syndrome
Rotator cuff injuries

Specialists

Occupational Therapist
Orthopedic (Orthopaedic) Surgeon
Physiatrist
Physical Therapist
Sports Medicine Physician

Comorbid Conditions

Bursitis
Diabetes mellitus
Infection of wound or skin
Osteomyelitis
Osteoporosis
Smoking

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Duration is determined by the grade of AC joint separation, whether the injury occurred on the dominant or the non-dominant side, and presence of other injuries. For non-dominant injuries, individuals may return to work earlier if duties can be performed with one hand. Dominant-side injuries may require longer disability, because individuals are not able to use their arm above the waist until healing is complete.

Disability may be longer for occupations that require manual dexterity, lifting, carrying, throwing, or overhead work. Surgical repair/reconstruction may increase the duration of disability.

Duration Trends from Reference Data

DURATION TRENDS

ICD-9-CM: 831.04, 831.14

Cases	Mean	Min	Max	No Lost Time	Over 6 Months
976	47	0	189	0.1%	0.2%

Percentile:	5^th	25^th	Median	75^th	95^th
Days:	7	21	37	63	119

Differences may exist between the duration tables and the reference graphs. Duration tables provide expected recovery periods based on the type of work performed by the individual. The reference graphs reflect the actual experience of many individuals across the spectrum of physical conditions, in a variety of industries, and with varying levels of case management. Selected graphs combine multiple codes based on similar means and medians.

Medical Codes

	ICD-9-CM:
	831 -	Dislocation of Glenohumeral Joint (Shoulder)
	831.04 -	Dislocation of Glenohumeral Joint (Shoulder), Closed, Acromioclavicular Joint
	831.14 -	Dislocation of Glenohumeral Joint (Shoulder), Open, Acromioclavicular Joint (Clavicle)

Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

What was the mechanism of injury?
Has diagnosis of AC joint dislocation been confirmed?
Was joint deformity present?
Did x-rays confirm a shoulder separation?
Was there a fracture in addition to dislocation? Other injuries?

Regarding treatment:

Did non-surgical treatment include strapping, bracing, splinting, or a sling?
Was surgery performed? Open reduction and/or internal fixation? Did individual experience any complications from surgical procedure?
Has individual received physical therapy?
Is individual actively participating in a home exercise program?
Has heavy lifting been avoided for 4 to 8 weeks? Have contact sports been avoided for at least 8 weeks?
Did conservative treatment fail?
Has late reconstructive surgery been recommended?

Regarding prognosis:

Has pain resolved?
Has function been restored? If not completely, to what degree?
How does this impact the individual's ability to perform daily activities or job requirements?
Would further rehabilitation increase functional ability?
Has individual experienced any complications?
Does individual have an underlying condition that may affect recovery?

Source: Medical Disability Advisor

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