Acromioclavicular joint dislocation: pathology, diagnosis and management

Dislocation is the most common injury affecting the acromioclavicular (AC) joint. Six grades of AC joint dislocation are currently described, based on the degree and direction, of displacement. Complete rupture of both the AC and coracoclavicular (CC) ligaments is considered to be necessary before complete grade 3 dislocation of the AC joint can occur. Diagnosis is made on the basis of the clinical history and examination, along with imaging results, with respect to the most common differential diagnoses. The literature indicates that conservative management is the most appropriate for grade 1 and 2 dislocations. Surgery, on the other hand, continues to be advocated for grades 4, 5 and 6. For grade 3 injuries, studies indicate that outcomes are similar for both conservative and surgical management. On this basis, conservative management is now also recommended as the preferred initial choice in grade 3 injuries. Further research is needed to clarify the type of conservative rehabilitation that results in the optimum outcome.