Schlegel and colleagues followed patients with acute grade III acromioclavicular separations managed without surgery to describe how they fared over the first year.
Prospective study at University of Utah and Salt Lake City Valley hospitals over 24 months: 25 patients enrolled, 20 tested at 1 year, plus 10 uninjured controls.
Methods
Design
Prospective study
24‑month enrollment at University of Utah and Salt Lake City Valley hospitals
Patients
25 enrolled with radiographic grade III separation
Excluded if prior shoulder injury, arthritis or neurologic deficit on the injured side
1 had surgery at 2 weeks for cosmetic concerns
4 interviewed by phone only and not analyzed
20 completed 1‑year testing
17 men and 3 women
Mean age 36.4 (range 19 to 52)
17 sports injuries and 3 motor vehicle accidents
10 uninjured subjects for dominant vs nondominant strength norms
Treatment
Sling for comfort
Early range of motion as tolerated
No formal physical therapy program
Follow-up
6, 12, 24, 36 and 52 weeks after injury
Outcomes
Subjective questionnaire and visual analog scales
Range of motion measured by one senior physical therapist
Isokinetic dynamometer strength (KinCom), 6 motions at 60 and 240°/s
Military press and bench press strength
Key Findings
Subjective results were favorable in 16 of 20 patients tested at 1 year, and 3 of the 4 with a poor result had secondary gain issues and declined surgery.
All 20 patients had full, pain‑free motion matching the uninjured side at 1 year, and rotational strength did not differ between sides.
Residual deformity was unacceptable to 5 of the original 25 patients, and 2 of them chose surgery, at 2 weeks and at 18 months.
A fixed prominence of the distal clavicle persisted in 14 of the 16 patients with favorable results.
Three of the 16 patients with favorable results reported fatigue with maximal overhead work, 2 of them construction workers doing repetitive manual tasks.
Patients wore the sling for an average of 8 days and returned to work after an average of 9 days.
Board pearl
Of all the strength measures, only the bench press differed significantly between sides in the short term, with the injured arm averaging 17% weaker.
Authors' conclusion
This study documents the natural history of patients with an untreated acute grade III acromioclavicular separation and provides a reference with which to judge all other proposed methods of treatment.
Schlegel and colleagues followed patients with acute grade III acromioclavicular separations managed without surgery to describe how they fared over the first year.
Prospective study at University of Utah and Salt Lake City Valley hospitals over 24 months: 25 patients enrolled, 20 tested at 1 year, plus 10 uninjured controls.
Methods
Design
Prospective study
24‑month enrollment at University of Utah and Salt Lake City Valley hospitals
Patients
25 enrolled with radiographic grade III separation
Excluded if prior shoulder injury, arthritis or neurologic deficit on the injured side
1 had surgery at 2 weeks for cosmetic concerns
4 interviewed by phone only and not analyzed
20 completed 1‑year testing
17 men and 3 women
Mean age 36.4 (range 19 to 52)
17 sports injuries and 3 motor vehicle accidents
10 uninjured subjects for dominant vs nondominant strength norms
Treatment
Sling for comfort
Early range of motion as tolerated
No formal physical therapy program
Follow-up
6, 12, 24, 36 and 52 weeks after injury
Outcomes
Subjective questionnaire and visual analog scales
Range of motion measured by one senior physical therapist
Isokinetic dynamometer strength (KinCom), 6 motions at 60 and 240°/s
Military press and bench press strength
Key Findings
Subjective results were favorable in 16 of 20 patients tested at 1 year, and 3 of the 4 with a poor result had secondary gain issues and declined surgery.
All 20 patients had full, pain‑free motion matching the uninjured side at 1 year, and rotational strength did not differ between sides.
Residual deformity was unacceptable to 5 of the original 25 patients, and 2 of them chose surgery, at 2 weeks and at 18 months.
A fixed prominence of the distal clavicle persisted in 14 of the 16 patients with favorable results.
Three of the 16 patients with favorable results reported fatigue with maximal overhead work, 2 of them construction workers doing repetitive manual tasks.
Patients wore the sling for an average of 8 days and returned to work after an average of 9 days.
Board pearl
Of all the strength measures, only the bench press differed significantly between sides in the short term, with the injured arm averaging 17% weaker.
Authors' conclusion
This study documents the natural history of patients with an untreated acute grade III acromioclavicular separation and provides a reference with which to judge all other proposed methods of treatment.