• falling on outstretched arm

• direct blow to sternum

• traction forces, which gymnasts typically endure

• Localized pain

• Pain in SC joint with motion (Specifically protraction and retraction)

• Varying degrees of deformity depending on grade of sprain

    Little pain, joint still stable, no deformity, ligament intact

Grade 2

    Pain, swelling, deformity, partial tearing of ligament, limited ROM, especially shoulder ABduction

Grade 3

    Pain, gross deformity, complete tearing of ligament

            ice to reduce inflammation

            arm sling to immobilize joint

        **if these fail, surgery may be necessary

• Direct blow to superior aspect of shoulder

• Lateral blow to deltoid area

• Falling onto an outstretched arm

Type I:

• Point tendernous over joint
• No laxity or deformity noted

Type II:

• Slight laxity and deformity
• Slight Step Deformity

Type III:

• Obvious dislocation of the distal end of clavicle from the acromion process

Type IV:

• Posterior clavicular displacement into the insertion of the upper fibers of the trapezius 

Type V:

• Displacement of clavicle 100% to 300% when compared bilaterally
• Clavicle displaced posteriorly with stripping of deltoid-trapezius aponeurosis

Type VI:

• Clavicle displaced inferiorly under the coracoid and possible involvement of brachial plexus

Type I

    Slight to partial damage of the AC ligament and capsule

Type II

    Rupture of the AC ligament and partial damage to the coracoclavicular ligament

Type III

    Complete tearing of the AC and coracoclavicular

Type IV

    Complete tearing of the AC and coracoclavicular ligaments; and tearing of the deltoid and trapezius fascia

Type V

    Same as type IV (*different signs and symptoms)

Type VI

    Same as type IV (*different signs and symptoms)

Types of AC joint sprains

www.aafp.org/afp/20041115/1947.html

AC Traction Test

  1. Patient is sitting or standing with the arm hanging naturally at their side

  2. Examiner stand lateral to involved side, grasping humerus proximal to elbow and opposite hand gently palpating AC joint

  3. Examiner applies a downward traction on the humerus

Positive Test: Humerus and scapula move inferior to clavicle, causing a step deformity, poin, or both.

AC Compression Test

  1. Patient is sitting or standing with the arm hanging naturally at their side

  2. Examiner stands on the involved side with hands cupped over the anterior and posterior joint structures

  3. Examiner squeezes the hands together, compressing the AC joint

Positive Test: Pain at the AC joint or excursion at the clavicle over the acromion process

 Treatment of AC joint sprains varies according to the severity of the sprain.

    Type I and II:

• Anti-inflammatory drugs

• Ice
• Sling immobilization

    Type II and Higher:

• Extended sling immobilization
• Surgical Intervention

http://www.wheelessonline.com/ortho/rotatory_stress_test_for_anterior_instability

GH Glide Test  

Positive Test: shown with pain or increased motion

compared to the opposite shoulder

• overhand follow-throughs (volleyball, baseball, tennis)

• blocking (football)

• overhead swimming strokes

GH Glide Test

   1. Position patient lying supine with GH joint over the edge of the table                                     
   2. Examiner stand lateral to side being tested, stabilizing the shoulder                     Positive Test: shown with pain or increased

   3. Apply gentle force moving the humeral head posteriorly to the                                motion compared to the opposite shoulder

       glenoid fossa while applying a slight distraction to the joint

• Weakness or damage to the rotator cuff

ABduction at 45 degrees:  damage to the anterior portion of glenohumeral ligament

ABduction at 90 degrees: damage to the posterior band of the glenohumeral ligament

Sulcus Sign

  1. Patient sitting with their arm hanging at their side

  2. Examiner stand lateral to the involved side, grip patient's arm distal to the elbow

  3. Apply downward traction force to the humerus

Positive Test: appearance of an indentation (sulcus) beneath acromion process,

humeral head moves away from clavicle and scapula

http://www.painok.com/shoulder/IMG/rosul.jpg