A to Z Entries
Clare E. Milner in Functional Anatomy for Sport and Exercise, 2019
The acromioclavicular joint is also considered part of the shoulder girdle, since the acromion process is part of the scapula. Several ligaments connect the clavicle to the scapula. At this joint, the acromioclavicular ligament is a thickening of the joint capsule, equivalent to the glenohumeral ligament at the glenohumeral joint. In addition, coracoclavicular ligaments, between the coracoid process and the clavicle assist in keeping the clavicle in place. These ligaments attach to the clavicle medial to the acromioclavicular joint and connect to the coracoid process inferiorly. There are two distinct coracoclavicular ligaments, the trapezoid and conoid, named according to their shape (trapezoidal and cone-shaped). The conoid is the more medial of the two. The important role of these ligaments becomes apparent after an acromioclavicular joint separation. This injury is a dislocation of the acromioclavicular joint which typically occurs as a result of a fall directly onto the shoulder. The severity of the injury is determined by the degree of separation of the clavicle from the acromion process. If only the acromioclavicular joint is torn, there is no apparent separation of the joint because the coracoclavicular ligaments keep the clavicle in place. In a more severe injury, the coracoclavicular ligaments are also torn, and the clavicle is now free to move superiorly and become separated from the acromion. In this case, the lateral end of the clavicle can be identified clearly under the skin as a bump on the superior aspect of the shoulder.
Musculoskeletal/injuries
Gina Johnson, Ian Hill-Smith, Chirag Bakhai in The Minor Illness Manual, 2018
Arthralgia is common; patients may be concerned that they have developed rheumatoid arthritis. Here is a brief overview: Shoulder pain: younger adults may suffer from dislocations or disorders of the acromioclavicular joint. In people aged 30–60, pain is most likely to be due to rotator cuff tendinopathy or a ‘frozen shoulder’; over the age of 60, osteoarthritis becomes more likelyElbow pain in an adult is most likely to be tennis elbowKnee pain in adolescents may be due to Osgood-Schlatter disease. In young adults, patellofemoral pain syndrome is common; in older adults, suspect osteoarthritisHip pain in older patients is most likely to be due to osteoarthritis or greater trochanteric pain syndrome. Beware hip pain and limp in children (slipped femoral epiphysis, Perthes’ disease)Thumb and finger pain is usually due to osteoarthritisToe pain is usually caused by gout if it occurs episodically
A Methodological Approach to the External Examination
Cristoforo Pomara, Vittorio Fineschi in Forensic and Clinical Forensic Autopsy, 2020
Any abnormal movement of acromioclavicular joint should be noted. External examination of the upper extremities should be performed from the shoulders downward to the hands, and any injuries of the dorsal and ventral sides should be noted. When self-incised wounds have been inflicted, they are usually superficial (hesitation marks), but they may be found adjacent to or overlying a fatal incised wound. When the decedent has attempted to ward off a pointed or sharp-edged weapon, defensive marks may be found on the palms of the hands, which is a result of attempts to grasp or ward off the knife. Defensive wounds may be found on the back (extensor surface) of the forearms and upper arms, and on the ulnar aspect of the forearms. In drug-related deaths, needle marks (recent or past) on elbows and wrists should be carefully investigated and recorded although there is little to be gained by testing the skin for drugs, as once a drug is in the body, it circulates everywhere, including the skin. If skin around an injection site is submitted for toxicological testing, it must be accompanied by a control sample of skin taken from the other arm. Hands should also be carefully examined as electrical marks are generally difficult to see unless the rigor of a flexed finger is overcome. Samples of the fingernails should be collected for later toxicological measurement as questions about drug use may arise at a later date.
Bilateral ultrasound findings in patients with unilateral subacromial pain syndrome
Published in Physiotherapy Theory and Practice, 2022
Anna Eliason, Marita Harringe, Björn Engström, Kerstin Sunding, Suzanne Werner
During the US examinations the patients were seated on a swivel chair with a low backboard, and the examiner was standing behind the patient. The tendons of supraspinatus, subscapularis, infraspinatus and the long head of biceps were visualized in both a longitudinal and transversal plane. Both the tendons of subscapularis and infraspinatus were evaluated dynamically during internal and external rotation with the forearm in supination and the elbow in 90° of flexion. The acromioclavicular joint was evaluated in terms of possible sprains and osteoarthritis. The supraspinatus tendon and the subdeltoid/subacromial bursae were evaluated dynamically during abduction with the arm slightly internally rotated. The supraspinatus tendon was examined with the patient’s palm placed on the posterior region of the iliac wing with the elbow flexed and directed posteriorly. The US examiner was blinded to arm dominance, the patient´s symptom as well as to the purpose of the study.
Applying a clinical decision-making model to a patient with severe shoulder pain ultimately diagnosed as neuralgic amyotrophy
Published in Physiotherapy Theory and Practice, 2022
Shoulder symptoms may be the most frequently encountered extremity diagnosis in general physical therapy practice and such symptoms account for about 10% of all patients seen in physical therapy (Kooijman et al., 2013). This creates a high economic burden for society with a mean annual cost of 4139 per patient, most of which was attributed to the cost of sick leave in a Swedish study (Virta, Joranger, Brox, and Eriksson, 2012). The shoulder is a particularly complex joint to examine due to the interrelations of the glenohumeral joint (GHJt), the acromioclavicular joint (ACJt), the sternoclavicular joint, the scapulothoracic joint, and cervical spine. The etiology of shoulder joint pain is diverse and includes pain from any of the joints mentioned above, as well as pain from the surrounding soft tissues, ligaments, nerves, and referral from the cervical spine or visceral organs including the heart and lungs. Pathologies involving the GHJt and surrounding soft tissues can include osteoarthritis, bursitis, rotator cuff tendinitis or tear, subacromial impingement, hypermobility, and labral defects to name only a few. Faced with so many possibilities, the differential diagnosis of shoulder pain can be challenging, even to the most experienced physical therapists. More purposeful and deliberate clinical decision-making processes may be helpful to physical therapists when faced with an unusual clinical picture.
Acromioclavicular joint injuries at a Colorado ski resort
Published in The Physician and Sportsmedicine, 2023
Naomi Kelley, Lauren Pierpoint, Jack Spittler, Morteza Khodaee
Acromioclavicular joint (ACJ) injuries (also known as separations or dislocations) are very common, accounting for up to forty percent of all shoulder injuries [1–4]. The AC joint is a diarthrodial joint where the clavicle can rotate and translate anteriorly, posteriorly and inferiorly in relation to its articulation with the acromion. The joint is composed of a meniscus-type structure of hyaline cartilage, surrounded by synovium [2]. Stability of the ACJ is provided horizontally by the acromioclavicular ligament, and vertically by the coracoacromial ligament. Although not directly attached to the acromion, two coracoclavicular ligaments (conoid and trapezoid ligaments) provide further vertical stability to the joint [5]. Overall, the anatomy of the ACJ provides resistance against significant forces.
Related Knowledge Centers
- Acromion
- Coracoacromial Ligament
- Scapula
- Joint
- Shoulder
- Clavicle
- Ligament
- Plane Joint
- Acromioclavicular Ligament
- Coracoclavicular Ligament