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Do all AC separations require surgery?
No. In fact the vast majority of AC separations do very well
with conservative treatment of the symptoms. Most AC injuries
are grade I, II, or III and these generally do not require
surgery. Usually the joint remains sore for two to six weeks
and then full return to activity is the norm. Only unstable
grade III injuries and high-energy AC separations, which are
often the result of motor vehicle accidents, require surgery
for full recovery.
Will the "bump" ever go away?
The clavicle will become stable in its newly elevated position,
but without surgery the "bump" will remain. The
joint will function normally and will not remain tender to
touch or movement. This minor cosmetic deformity will persist
but will not interfere with overhead activities or participation
in sports.
Are there downsides to a resection of the AC joint?
An AC resection is a procedure in which the end of the clavicle
is removed and the acromioclavicular ligament in reattached
into the end of the clavicle to replace the ligament torn
during injury. Once the initial injury has healed and the
clavicle has regained stability from scar tissue there is
no functional loss with an AC resection. In the rare instance
that the AC joint remains painful after a separation, but
does not require stabilization, an AC resection is very effective
in relieving pain without sacrificing function. If, however,
the clavicle is unstable at the time of resection, a full
reconstruction of the coracoclavicular ligaments is necessary
to maintain the stability of the upper extremity.
Will I be able to return to athletics if an AC injury is not treated?
Absolutely.
Most athletes in contact sports have had a low energy AC separation
at some time in their careers. Except for the slight deformity
that remains, there is no clinical significance to a healed
AC separation. Occasionally high-energy AC separations that
have disruption of the AC and CC ligaments will require surgery,
but these injuries are usually apparent early on with a correct
X-ray evaluation. Grade I, II, and most grade III AC separations
will heal without treatment and a full return to sports can
be expected.
References
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