BLOG: Case study 52-year-old right hand-dominant woman
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by Sam Dyer, PA-C, MHS
A 52-year-old right hand-dominant woman was seen in the orthopedic clinic after sustaining a fall from a horse. She had increased shoulder pain and loss of motion. She reported pain primarily along the superior aspect of her shoulder with no numbness or tingling in the arm or hand. She had no loss of grip and was distal neurovascular intact. She did notice a “hard knot” over the posterior/superior shoulder that was painful.
The initial radiographs are shown here:
The diagnosis was discussed with the patient and the decision was made for surgery. What is the diagnosis?
Discussion
This patient has an uncommon acromioclavicular (AC) separation that is actually best determined by the trauma axillary view (see arrows). Notice the posterior position of the distal clavicle with relation to the AC joint? It is a grade IV separation where the clavicle has penetrated the trapezius posteriorly. She had open reduction with internal fixation with repair of the AC ligament and reconstruction of the coracoclavicular ligaments with a hamstring allograft.