| Grade I and II injuries respond well to non-surgical (conservative) treatment with ice, analgesics, and immobilization. Early physical therapy (day 4) will help the individual regain full range-of-motion.
There is controversy about the role of surgery in Grade III dislocations. Conservative treatment of grade III dislocation begins with closed reduction followed by application of a sling or harness (Kenny-Howard sling) to keep the clavicle and acromion in proper alignment. Ice and analgesics help control pain and early physical therapy helps the individual regain full range-of-motion. Usually, surgical intervention is considered only when the individual has failed to heal with conservative treatment, is a professional athlete, or performs heavy lifting or overhead work.
Grade IV through VI injuries are treated surgically with open reduction internal fixation (ORIF), a surgical procedure that realigns the bones and reconstructs the ligaments. Screws, wires, or non-absorbable sutures may be used to hold the joint in place while the reconstructed ligaments heal. During the healing phase, shoulder motion is increased gradually to restore full range of motion. The individual usually regains full use of the shoulder about 10 weeks after surgery. ORIF usually leaves a scar about 2 inches long over the AC joint.
Any surgical procedures for AC dislocation must accomplish three objectives: 1) expose and remove any damaged tissue from the AC joint (débridement), 2) repair torn and damaged ligaments, and 3) achieve a stable reduction of the AC joint. Arthroscopic techniques using fiber-optic instruments and a smaller incision have been used for AC joint fixation with good results (Canale), but most orthopaedic surgeons prefer open procedures. |
Source: Medical Disability Advisor