Acromioclavicular joint and distal clavicle injuries

Purpose of review: There are a variety of physical examination maneuvers described in the literature that are positive in the setting of acromioclavicular joint pathology. The value of any one particular positive finding is debatable. Similarly, effective treatment of acute and chronic acromioclavicular joint separations has been a subject of debate in recent years. Most acromioclavicular joint separations have historically been treated in a closed manner. However many surgeons are now opting to treat these injuries surgically. One aim of this review is to summarize the results of recent physical examination investigations so that the reader may be better equipped to accurately diagnose problems with the acromioclavicular joint. The second aim of this paper is to educate the reader on the biomechanics of acromioclavicular joint stability and the implications of this new knowledge on surgical interventions. Recent findings: Over the past year there have been two excellent systematic investigations of physical examination findings in the setting of acromioclavicular joint pathology. These studies significantly contribute to our knowledge of how to properly examine the acromioclavicular joint. Likewise, several investigators have methodically studied the biomechanics of the normal acromioclavicular joint, the separated acromioclavicular joint and the surgically reconstructed acromioclavicular joint. This new knowledge is sure to lead to more effective treatment algorithms for acromioclavicular joint separation. Summary: Upon completion of this review the reader will be enlightened on how to better diagnose afflictions of the acromioclavicular joint and will be armed with objective basic science data on acromioclavicular joint biomechanics. This new knowledge may change our perspective on diagnosis and treatment of acromioclavicular joint pathology.