Shoulder Dislocation (Continued)

The most common mechanism of injury of the AC joint is a direct blow downward on the top, or point, of the shoulder. This occurs when the shoulder is driven into the ground with great force, such as a player being tackled in football. It may also occur in hockey, baseball, and wrestling when the shoulder impacts another player or object. The moment this occurs there is excruciating pain and a deformity in the joint, if the force is great enough.

AC joint sprains can be classified into three categories: Grades I, II, and III. Grade I involves a mild stretching of the joint capsule and ligaments with no obvious deformity and some tenderness and swelling. Grade II involves a significant tearing of the ligaments and obvious deformity. Grade III is a complete disruption, or tear, of the ligaments with significant joint deformity. The usual treatment for this injury is a figure eight splint to keep the joint immobile while the healing process occurs. Grade III, or complete tears, used to be treated with surgery, but are now treated conservatively, except in cases where there is an associated fracture or the clavicle is grossly out of place.

This is another example of studies showing that the best approach is the most conservative approach. While the initial immobilization may relieve pain, weakening of the ligaments will occur if the immobilization continues indefinitely. Physical therapy and an exercise program may restore strength and function to the shoulder, but the injured ligaments may continue to grind, pop, click, and cause pain, especially with overhead activities and when reaching across the chest. Because these activities put strain on the ligaments, the surrounding muscles may go into spasm and become chronically painful, inhibiting the athlete's ability to use the shoulder normally. The physician will note tenderness with possible deformity over the AC joint and tenderness at the coracoid process. A positive jump sign may also be noted when the physician palpates the surrounding muscles. One point to remember is that a grinding or crunching sound in any joint is not normal. This is a sign of ligament laxity causing excessive joint motion, producing the grinding sensation.

Once first line treatments have been unsuccessful, Prolotherapy maybe tried. Injections made at the AC joint and at the insertion of the ligaments on the clavicle, coracoid process, and acromion process will initiate a healing process in these structures and will result in the resolution of pain and a return of normal function. The Prolotherapy, by strengthening the AC joint and the many structures that attach to the coracoid, makes an athlete's shoulder much more stable. As the shoulder becomes more stable, it follows that athletic performance is enhanced.

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