Acromial end of the clavicle: structure, trauma, disease, treatment

The clavicle is the only bone that connects the upper limb to the skeleton of the body. It belongs to the tubular bones, but its structure is spongy. There is no bone marrow in it. The clavicle is the first among other bones to receive a ossification point, but finally this process in it ends only by the age of 25. Consider its main features.

A bit of anatomy

The collarbone has an S-shape: two ends (acromial and sternal) and the body. The sternum, as the name suggests, is located towards the sternum. He is slightly bent forward. The acromial end of the clavicle is bent backwards. It is wider, articulated with a shoulder blade. The location of the clavicle is called the main, as important blood vessels pass near it.

The articular surfaces of this bone are lined with cartilaginous tissue. Fiber and ligaments are attached to the collarbone, which hold it in position. In the articulation, movements along several axes can be made, but because of the ligamentous apparatus, mobility decreases, so the amplitude of movements is minimal. This allows not only to hold the limb in the shoulder girdle, but also to serve as a support. This function may be impaired by various factors. The acromial end of the clavicle is most often prone to dislocations, fractures, torn ligaments, arthrosis. In very rare cases, inflammation can develop, but since there are soft tissues around the joint, infections are difficult to penetrate inside the capsule.

Articulation gap

This injury of the acromial end of the clavicle takes 3rd place in the frequency of cases. At risk are athletes, young and overly active people. Pathology occurs with a direct fall on the shoulder. In this case, the ligamentous apparatus that surrounds the acromial end of the clavicle is damaged. If the blow is strong enough, the ligaments break, the scapular part is separated from the clavicle. Since the upper limb will pull the shoulder blade down, a tubercle appears over the shoulder.

Causes

Articulation rupture can occur in the following cases:

1. Injury during sports, for example, goalkeepers of hockey or football teams, who often catch the ball or trying to hit the puck, fall on the shoulder.
2. Contact sports injuries such as sumo, judo, boxing and others.
3. Falling on an elongated upper limb, for example, during ice.
4. Too active lifestyle that leads to a fall, for example, roller-skating, skiing and so on.

Symptomatic manifestations

Experienced doctors can determine the rupture of the acromioclavicular joint according to their clinical signs, typical manifestations are as follows:

1. Visual lengthening of the upper limb, shortening of the upper arm.
2. Pain in the left shoulder when falling to the left side, or in the right, respectively, on the right.
3. The strength of the limb decreases, its mobility is limited.
4. When you click on the clavicle, a "keyboard syndrome" is observed.
5. The presence of bruising, a person’s shoulder swells strongly and quickly.

Treatment principles

Depending on the degree of damage and the general condition of the patient, the treatment can be conservative or surgical. Drug treatment involves the use of:

• Supportive dressings.
• Cold compresses.
• Painkillers.

If necessary, a bandage may be applied to the joint.

As for surgical treatment, it consists in eliminating serious bone deformities. During the operation, ligaments are restored, and in severe cases, the end of the clavicle can be removed.

Dislocation

Dislocation of the acromial end of the clavicle is not uncommon. This phenomenon occurs under the influence of indirect force, when falling on the arm or when hitting the shoulder blade.

With a dislocation, a person’s shoulder is visually deformed. The damaged area sticks out and a “keyboard syndrome” appears. Pain appears in the left shoulder or in the right shoulder (with an injury on the right side of the body), swelling, a person cannot move a damaged limb, after a while a hematoma appears.

There are two treatment options. Each has its own indications and contraindications.

The conservative method is to dislocate the end of the clavicle and apply plaster. Before the reduction procedure, the doctor performs local anesthesia, then a cotton or gauze roll is placed under the damaged area. At the same time, the doctor presses on the collarbone. Thus, only subluxations or incomplete dislocations can be treated. In addition, the likelihood of relapse is very high.

Therefore, most often dislocation is treated by surgical intervention. Doctors use screws, buttons, plates or knitting needles. In some cases, plastic ligaments are indicated.

Fracture

A fracture of the acromial end of the clavicle is often observed in children, active young people and athletes. The main reason is a fall on the shoulder joint or an arm laid aside. With a direct shoulder stroke, a fracture is observed much less frequently.

A broken clavicle has the following clinical picture:

• A person automatically supports the upper limb.
• The shoulder is shifted down and forward.
• Severe pain that does not allow to raise a hand.
• Swelling.
• Hemorrhage.
• Crunch while trying to raise a hand.

It must be said that a single visual examination cannot provide accurate information about the damage, so the patient is sent for an x-ray. Perhaps the x-ray will show a crack in the acromial end of the clavicle, a classic fracture or a fracture with an offset. All this affects the choice of therapy.

The treatment can again be of two kinds. The conservative method is to eliminate the displacement (if any) and the fixed fixation of the joint for a period until the bone is completely fused. Often, this treatment option does not lead to a positive effect - the shoulder girdle can be shortened and deformed. In addition, a long period of splicing of a broken collarbone significantly affects the patient's quality of life. In this case, it is preferable to carry out surgery - osteosynthesis. The essence of the operation is the elimination of debris and fixation of the bone with a metal plate. Sometimes the plate is removed after a few months, but most often it is left for life.

Osteolysis

Osteolysis of the acromial end of the clavicle is a rare pathology that is accompanied by resorption of bone tissue. For what reasons this phenomenon occurs, scientists still have not figured out. Only the relationship of pathology with autoimmunization of bone tissue is known. This disease is characterized by the absence of a pain symptom. The clinical manifestation of the disease is poor bone growth during fractures. As for radiography, osteoporosis is visible in the pictures - a strain of bone tissue.

Arthrosis

Arthrosis of the clavicular-acromial joint is diagnosed less frequently than brachial arthrosis. The causes of pathology are:

• Frequent shoulder loads - professional activities, sports.
• Injuries.
• Inflammatory processes in the joint cavity and in the soft periarticular tissues.
• The physiological causes are aging of the body.
• Endocrine Disorders
• Deterioration of joint nutrition, congestion, slowing down of metabolic processes, circulatory disturbance.

With the destruction of articular cartilage, the following processes develop:

• Compaction of the cartilage bone.
• The appearance of microcavities, which merge with each other, as a result of which bone growths are formed - osteophytes.
• Dead cartilage fragments and osteophytes, irritating the synovial membrane, provoke an inflammatory process, that is, synovitis occurs.
• The joint is deformed, its edges can significantly protrude through the skin.

Symptoms

Arthrosis of the clavicular-acromial joint is accompanied by the following clinical picture:

• Pain that becomes stronger after exertion and towards the end of the day.
• Fatigue.
• Limited mobility of the joint, especially after waking up.
• Crunches and clicks.
• Joint deformation, visible visually.

If the symptoms of arthrosis of the acromioclavicular joint are accompanied by a restriction of motor function in the shoulder girdle, this indicates that degenerative-dystrophic processes also affected the shoulder joint.

Diagnostics

Diagnosis of pathology is based on such manipulations:

• Visual inspection and palpation.
• Functional tests.
• Diagnostic blockade inside the joint.
• X-ray, ultrasound, CT, MRI.
• Laboratory tests.

Treatment principles

In the early stages of the disease, light painkillers and chondroprotectors are prescribed, but as the disease progresses, stronger drugs will be needed - non-steroidal anti-inflammatory drugs, hormonal blockades, narcotic painkillers. With muscle cramps, muscle relaxants are prescribed. Ointments and other external agents are often used. They not only eliminate pain, but also improve blood circulation, tissue trophism.

Physiotherapy for arthrosis of the acromioclavicular joint:

• Massage.
• Electrophoresis
• Magnetotherapy.
• Laser Therapy
• Ural Federal District.
• Sinusoidal currents.

Surgery is a rare case. But if it is required, most often an atroscopic resection of the acromion is performed.

Rehabilitation after joint surgery

In order for the recovery process to go faster and not be accompanied by complications, after the operation, the limb must remain motionless for a long time. Next, the patient must undergo a course of physiotherapy, as well as exercise therapy. In addition, massage is prescribed. Of the physiotherapeutic procedures, UHF is most often used. In this case, the damage area is affected by fields of different frequencies. Metabolism normalizes, damaged ligaments are restored, swelling subsides, tissue healing accelerates. Massage improves the outflow of lymph, reduces swelling, helps restore blood circulation. There are no contraindications for massage. This procedure is allowed when recovering from various injuries, as it facilitates the development of muscles that atrophy after prolonged immobility.