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    • #10370
      Linh
      Participant

      Dear Steve,

      I had a patient who fell down and hit his ACJ against a hard surface. There is pain from ACJ towards the upper neck. I measure the distance between the acromion and clavicle tips to be 7mm horizontally and 4mm vertically. I can also see the pockets of fluid underneath the joint and as the patient forward flex, the capsule budges as the tips got markedly close to each other. No Rotator cuff tears or joint effusion.

      What is your criteria in diagnosing ACJ instability and differentiating it from a hypermobile ACJ?

      Best regards,
      Linh

    • #10388
      Stephen Bird
      Keymaster

      Interesting,

      AC joints get degenerative change early in life so I think the age of the patient makes a difference after trauma.

      If they are young, for example 25 and you are seeing these changes they are likely related to the trauma but in an older patient you are seeing normal for age AC point degenerative changes.
      I use forward flexion and expect the acromion and the clavicle to squeeze together a bit in a normal patient. If the clavicle rises superiorly relative to the acromion this is evidence of AC joint instability. Everything about the AC joint is designed to hold the clavicle down. The joint itself as well as the conoid and trapezoid coraco-clavicular ligaments hold the clavicle down. If the clavicle rides up the joint is unstable.

      Steve

    • #10633
      Linh
      Participant

      Right, I think it is a normal degenerative ACJ in my case as the patient is middle-aged, the clavicle goes down to the same level as the acromion with forward flexion and the joint gets narrower during this manoeuvre. Report of his ACJ Xray NAD.

      Thanks Steve.

    • #10710
      Stephen Bird
      Keymaster

      I agree completely,

      You will see this finding very commonly in this demographic.

      Steve

    • #46925
      Sandra St Cyr
      Participant

      I just want to add that recently I have added forward flexion to my assessment of ac joints – especially when the patient is point tender at ac joint and in the past 6 months have picked up 3 cases of ac joint instability!!!
      Yay Steve, another point for you !!!
      It’s not uncommon that my msk Rad will ask if I learned that from you lol

    • #46926
      Stephen Bird
      Keymaster

      You are funny Sandy,

      Yes, forward flexion certainly loads the joint nicely and if it is unstable it will demonstrate this.

      Have a great week up there.

      Steve.

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