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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)

Prognosis

Early repairs achieve satisfactory results in 96% of cases, whereas late reconstruction achieves satisfactory results in 77% of cases (Canale). Grade III injuries treated conservatively without surgery may return to normal function and activity without restriction in approximately 6 to 8 weeks. Grade III injuries, however, do not always respond to conservative therapy, especially if there has been damage to the disc of cartilage between the acromion and clavicle, damage to capsular ligaments, of if there are fragments of articular cartilage between the acromion and the clavicle. Recovery from grade IV to VI injuries occurs more slowly due to associated injuries to surrounding structures.

Injury to an individual’s dominant side may be accompanied by loss of strength in the shoulder joint. This may not restrict the activities of most individuals but can have serious consequences for individuals whose jobs require heavy lifting, overhead work and for athletes who participate in contact sports and/or throwing.

While the predicted treatment outcome is good, chronic pain and decreased joint function from degenerative arthritis develop in a small percentage of individuals as they age. If AC joint arthritis becomes disabling, it may be treated by a Mumford procedure, in which the distal clavicle is surgically resected to remove the diseased joint (arthropathy).

Source: Medical Disability Advisor

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