Subluxation of Clavicle - (collar bone) ???? - ABCbodybuilding

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Old 03-31-2006, 05:25 PM
JulianJames JulianJames is offline
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Default Subluxation of Clavicle - (collar bone) ????

Hello all,

I posted here before becaouse I discovered that my right clavicle (collar bone) had experienced 'subluxation' (partial dislocation...

Has anyone not experienced this? or knows someone that has?

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Old 04-05-2006, 08:46 AM
G o r t G o r t is offline
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Default Re: Subluxation of Clavicle - (collar bone) ????

Don't really know , but you will have to do something.

I can't link directly to this arcticle From Medscape so I will quote.

Acromioclavicular Injuries: New Management Options Emerge

Raffy Mirzayan, MD Keck School of Medicine

Acromioclavicular separations are one of the most common shoulder injuries seen in young athletes. They usually result as a direct blow to the shoulder. Several ligaments stabilize the clavicle to the scapula. The anterior, posterior, inferior, and superior acromioclavicular ligaments stabilize the clavicle to the acromion, with the superior ligament being most important. The coracoclavicular ligaments, the conoid and trapezoid, are strong ligaments which stabilize the clavicle to the coracoid process of the scapula. Separations are divided into 6 types,[1] and treatment is decided upon on the basis of the type of separation. A type I separation is a sprain of the acromioclavicular ligaments with no subluxation of the clavicle, and a type II is a partial superior subluxation of the clavicle with a sprain of the coracoclavicular ligaments. These 2 types are treated nonoperatively. Type III separations involve 100% displacement of the clavicle with complete tears of the coracoclavicular ligaments. These separations are subdivided into acute and chronic. Most surgeons agree that acute tears and asymptomatic chronic tears do not require surgical intervention. Symptomatic chronic type III separations do require surgery to stabilize the clavicle. In a type IV separation, the clavicle is posteriorly subluxed. Type V is a 200% to 300% superiorly subluxed clavicle in which the deltotrapezial fascia is torn. Type VI is an inferiorly subluxed clavicle in which the clavicle is locked under the coracoid process. Types IV-VI are treated surgically in an acute setting.

Several operations have been reported to stabilize the clavicle. Over 60 variations have been reported in the literature. The most commonly used procedure is the modified Weaver-Dunn. The end of the clavicle is excised and the coracoacromial ligament is released from the undersurface of the acromion. Sutures are sewn into the ligament, and the ligament is then secured into the end of the clavicle, where the sutures are tied over a bone bridge. This operation has yielded satisfactory results, but several methods of augmentation have been used to strengthen the construct. These have included cerclage wires, suture anchors, screws, synthetic grafts, and, more recently, allograft tendons.

Recently, there has been renewed interest in reconstruction of the acromioclavicular joint separations. Several biomechanical studies have been performed to evaluate the load that triggers the failure of native ligaments and to compare different repair techniques. Most of the recent work has been performed by Augustus Mazzocca, MD, Department of Orthopaedic Surgery, University of Connecticut School of Medicine, and by Richard Debski, MD, Department of Orthopaedic Surgery, Musculoskeletal Research Center, University of Pittsburgh. The new attention is the anatomic reconstruction of the coracoclavicular ligaments using tendon grafts. These grafts are looped around the coracoid process and then are placed through or around the clavicle, and are secured by either suturing the graft to itself or by interference screws.

At the American Orthopaedic Society of Sports Medicine (AOSSM) annual meeting, July 14-17, 2005, Keystone, Colorado, Dr. Mazzocca highlighted options for acromioclavicular joint reconstruction.[2]

Dr. Mazzocca has been performing anatomic reconstructions of the coracoclavicular ligaments using either semitendinosus or gracilis auto- or allograft tissue. The graft is either looped under the coracoid or is fixed into it using a 5.5-mm interference screw. By performing anatomic dissections and examining the osteology of the clavicle, Dr. Mazzocca has determined that the conoid is a posterior structure and is, on average, 46 mm medial from the end of the clavicle. The conoid tubercle is an average of 25 mm from the midpoint of the trapezoid line. Therefore, his anatomic reconstruction is aimed at placing one limb of the graft posteriorly to reconstruct the conoid, whereas another limb of the graft is placed anteriorly to reconstruct the trapezoid ligament. Bone tunnels are drilled in a vertical direction and the graft limbs are passed through the clavicle at these determined positions. The graft limbs are then secured using 5.5-mm interference screws. Biomechanical testing of this repair construct has shown that there is significant decrease in anterior and posterior displacement in comparison to a modified Weaver-Dunn reconstruction, but that there is no significant difference in superior displacement. Dr. Mazzocca reported on 12 patients (2 revisions), 4 with more than 2 years of follow-up and 6 with more than 6 months of follow-up without any failures.

Stephen J. Nicholas, MD,[3] reported on the functional outcomes of coracoclavicular reconstructions with tendon grafts." Eight patients (mean age, 39 years) underwent coracoclavicular ligament reconstructions using a tendon graft (7 hamstring allografts and 1 toe extensor autograft). The tendon graft was looped under the coracoid process. A hole was drilled in the clavicle. One limb of the graft was passed through the drill hole, then the graft ends were tied into a knot. Sutures were placed through the tendon ends for additional fixation. The patients were evaluated at an average of 17 months. On follow-up, none of the patients presented with a side-to-side acromioclavicular joint alignment difference on radiographs. On functional closed kinetic chain tests, the patients scored 16% better than the standardized norms. The PENN shoulder score was 95 out of 100, and the ASES score was 93 out of 100. The simple shoulder test score was 11.4 out of 12, and the acromioclavicular separation questionnaire was 28 out of 30. There were minimal losses of motion and strength. The study authors concluded that their technique of coracoclavicular ligament reconstruction using tendon grafts leads to excellent functional results with high patient satisfaction and minimal loss of motion and strength.

Although most of the information in the literature about acromioclavicular separations emanates from the experience of the recreational athlete, there are few data that detail methods of managing this injury in elite professional athletes. Dr. Theodore "Ted" Schlegel, MD,[4] team physician of the Denver Broncos, presented "Grade III Acromioclavicular Separation in National Football League Quarterbacks." The best method of treatment in these high-level athletes is unknown; for this reason, the study authors sought to determine the outcomes of acromioclavicular separations in high-level overhead athletes.

In this retrospective study, they identified NFL quarterbacks who sustained a type III separation using the NFL database and sent a directed questionnaire which was filled out by the team's medical staff. They were able to identify 15 quarterbacks in this time period. Twelve of the 15 were initially treated nonoperatively. Five were injured on the dominant side and 7 on the nondominant side. Of those injured on the dominant side, 3 were treated with a Kenny-Howard sling and were immobilized for 3 weeks, returned to throwing in 5-6 weeks, and missed between 6 and 10 games. The other 2 were treated with a sling or tape, were immobilized for 7-10 days, returned to throwing in 4 weeks, and missed 5 games. The study authors concluded that nonoperative treatment can lead to acceptable results in a small group of NFL quarterbacks, especially if it involves the nondominant shoulder. Operative treatment may lead to a more predictable result for players with injury of the dominant shoulder.

Rockwood CA Jr. Injuries to acromioclavicular joint. In: Rockwood CA Jr, Green (!@#$%^&*), eds. Fractures in Adults. Vol 1. 2nd ed. Philadelphia: JB Lippincott; 1984:860-910, 974-982.
Mazzocca AD. Spotlight on Surgical Techniques: AC joint reconstruction. Program and abstracts of the American Orthoapaedic Society of Sports Medicine Annual Meeting; July 14-17, 2005; Keystone, Colorado.
Nicholas SJ, Lee SJ, Mullaney M, Tyler TF, McHugh MP. Functional outcomes of coracoclavicular reconstructions with tendon grafts. Program and abstracts of the American Orthopaedic Society of Sports Medicine Annual Meeting; July 14-17, 2005; Keystone, Colorado.
Schlegel TF, Boublik M, Hawkins RJ. Grade III acromioclavicular separations in NFL quarterbacks. Program and abstracts of the American Orthopaedic Society of Sports Medicine Annual Meeting; July 14-17, 2005; Keystone, Colorado.

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