Presentation
Shoulder pain post football injury.
Patient Data
Widening of the acromioclavicular joint with elevation of the distal clavicle compared to the acromion.
No abnormality of the infraspinatus, supraspinatus or teres minor tendons. Interstitial tear of subscapularis. The long head of biceps tendon is enlocated within the bicipital groove and has a normal intraarticular course. No findings of rotator cuff muscle belly atrophy or acute denervation. Small volume of excess fluid within the subacromial bursa.
There is widening of the acromioclavicular joint, up to 10mm, with disruption of the
acromioclavicular ligaments and peri-articular hyperintensity. Superior subluxation of the
distal clavicle compared to the acromion without anterior/posterior displacement. Mild
hyperintensity of the insertions of trapezius and deltoid muscles but no significant tear. There is hyperintensity of the coracoclavicular ligament with some fibers thought to be intact in keeping with high-grade sprain injury. The coracoclavicular distance is approximately 20mm.
No glenohumeral joint effusion. Articular cartilage is preserved. Glenoid labrum is intact. No evidence of previous glenohumeral instability or adhesive capsulitis. No suspicious focal osseous lesion.
Case Discussion
This injury is compatible with a Rockwood type 2, typically managed non-operatively, although this is borderline type 3 with a high-grade sprain injury of the coracoclavicular ligament and the CC distance being 20 mm is almost double what is considered normal.
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