The clavicle is the only bone that connects the upper limb to the skeleton of the torso. It belongs to the tubular bones, but its structure is spongy. There is no bone marrow in it. The clavicle is the first among other bones to receive an ossification point, but this process is finally completed in it only by the age of 25. Consider its main features.
A bit of anatomy
The clavicle has an S-shape: two ends (acromial and sternal) and a body. The sternal, as you might guess from the name, is located towards the sternum. It is slightly bent forward. The acromial end of the clavicle is bent backwards. It is wider, articulates with the scapula. The location of the collarbone is called the main one, since important blood vessels pass near it.
The articular surfaces of this bone are lined with cartilage. Attached to the collarbone are fibers and ligaments that hold it in position. In the joint, movements can be made along several axes, but due to the ligamentous apparatusmobility decreases, so the range of motion is minimal. This allows not only to hold the limb in the shoulder girdle, but also to perform the function of a support. This function can be impaired under the influence of various factors. The acromial end of the clavicle is most often prone to dislocations, fractures, torn ligaments, arthrosis. In very rare cases, inflammation may develop, but since there is soft tissue around the joint, it is difficult for infections to enter the capsule.
Articulation tear
This injury to the acromial end of the clavicle is the 3rd most common injury. Athletes, young and overly active people are at risk. Pathology occurs with a direct fall on the shoulder. In this case, the ligamentous apparatus that surrounds the acromial end of the clavicle is damaged. If the blow is strong enough, the ligaments are torn, the separation of the scapular part from the collarbone occurs. Since the upper limb will pull the shoulder blade down, a bump appears above the shoulder.
Reasons
Rupture of the joint can occur in the following cases:
- Injury during sports activities, such as hockey or football go altenders, who often fall on their shoulder while catching the ball or trying to hit the puck.
- Injury from contact sports such as sumo, judo, boxing and others.
- Falling on an outstretched upper limb, for example, during ice.
- Too active lifestyle that leads to falls, such as rollerblading, skiing, etc.
Symptomatic manifestations
Experienced doctors can determine the rupture of the acromioclavicular joint by clinical signs, typical manifestations are as follows:
- Visual lengthening of the upper limb, shortening of the shoulder girdle.
- Pain in the left shoulder when falling on the left side, or in the right, respectively, on the right.
- The strength of the limb is reduced, its mobility is limited.
- When pressing the collarbone, there is a "keyboard syndrome".
- The presence of bruising, the person's shoulder swells strongly and quickly.
Principles of treatment
Depending on the degree of damage and the general condition of the patient, treatment can be conservative or surgical. Drug treatment involves the use of:
- Support bandages.
- Cold compresses.
- Painkillers.
If necessary, a bandage may be applied to the joint.
As for surgical treatment, it consists in the elimination of serious deformations of the bone tissue. During the operation, the ligaments are repaired, and in severe cases, the end of the collarbone can be removed.
Dislocation
Dislocation of the acromial end of the clavicle is far from uncommon. This phenomenon occurs under the influence of an indirect force, when falling on a hand or when hitting a shoulder blade.
When a person's shoulder is dislocated, it visually deforms. The area of damage sticks out and a "key syndrome" appears. Pain appears in the left shoulder or in the right shoulder (with an injury on the right side of the body),swelling, a person cannot move the injured limb, after a while a hematoma appears.
There are two treatment options. Each has its own indications and contraindications.
The conservative method is that the dislocated end of the clavicle and apply a cast. Before the reduction procedure, the doctor performs local anesthesia, then a cotton or gauze roller is placed under the damaged area. At the same time, the doctor presses on the collarbone. Thus, only subluxations or incomplete dislocations can be treated. In addition, the chance of relapse is very high.
Therefore, most often a dislocation is treated with surgery. Doctors use screws, buttons, plates, or wires. In some cases, ligament plastic surgery is indicated.
Fracture
Fractures of the acromial end of the clavicle are common in children, active young adults and athletes. The main reason is a fall on the shoulder joint or an outstretched hand. With a direct shoulder impact, a fracture is much less common.
A broken collarbone has the following clinical picture:
- The person automatically supports the upper limb.
- The shoulder is displaced down and forward.
- Severe pain that prevents you from raising your arm.
- Puffiness.
- Hemorrhage.
- Crunch when trying to raise hand.
I must say that one visual examination cannot give accurate information about the damage, so the patient is sent for an x-ray. Perhaps an x-ray will show a crackacromial end of the clavicle, classic or displaced fracture. All this influences the choice of therapy.
Treatment can again be of two kinds. The conservative method is to eliminate the displacement (if any) and immovable fixation of the joint for a period until the bone is completely fused. Often, this treatment option does not lead to a positive effect - the shoulder girdle can be shortened and deformed. In addition, a long period of fusion of a broken collarbone significantly impairs the patient's quality of life. In this case, it is preferable to carry out surgical intervention - osteosynthesis. The essence of the operation is the elimination of fragments and fixation of the bone with a metal plate. Sometimes the plate is removed after a few months, but most often it is left for life.
Osteolysis
Osteolysis of the acromial end of the clavicle is a rare pathology that is accompanied by bone resorption. For what reasons this phenomenon occurs, scientists have not yet figured out. Only the relationship of pathology with autoimmunization of bone tissues is known. This disease is characterized by the absence of pain symptoms. The clinical manifestation of the disease is poor fusion of bones in fractures. As for the x-ray, the pictures show osteoporosis - a thinning of the bone tissue.
Arthrosis
Arthrosis of the clavicular-acromial joint is diagnosed less frequently than shoulder arthrosis. The causes of pathology are:
- Frequent load on the shoulder - professional activities, sports.
- Injuries.
- Inflammatory processes in the joint cavity and in soft periarticular tissues.
- Physiological causes - aging of the body.
- Endocrine disorders.
- Deterioration of joint nutrition, congestion, slowing down of metabolic processes, circulatory disorders.
When the articular cartilage is destroyed, the following processes develop:
- Consolidation of the subchondral bone tissue.
- The appearance of microcavities that merge with each other, resulting in the formation of outgrowths of bone - osteophytes.
- Dead cartilage fragments and osteophytes, irritating the synovial membrane, provoke an inflammatory process, that is, synovitis occurs.
- Deformation of the joint occurs, its edges can significantly protrude through the skin.
Symptoms
Arthrosis of the clavicular-acromial joint is accompanied by the following clinical picture:
- Pain that gets worse after exertion and towards the end of the day.
- Fatigue.
- Restriction of joint mobility, especially after waking up.
- Cracks and clicks.
- Deformation of the joint, noticeable visually.
If the symptoms of arthrosis of the acromioclavicular joint are accompanied by a limitation of motor function in the area of the shoulder girdle, this indicates that degenerative-dystrophic processes have also affected the shoulder joint.
Diagnosis
Diagnosis of pathology is based on such manipulations:
- Visual inspectionand palpation.
- Functional trials.
- Diagnostic blockade inside the joint.
- X-ray, ultrasound, CT, MRI.
- Laboratory tests.
Principles of treatment
In the early stages of the disease, light painkillers and chondroprotectors are prescribed, but with the progression of the disease, stronger means will be required - non-steroidal anti-inflammatory drugs, hormonal blockades, narcotic painkillers. With muscle spasms, muscle relaxants are prescribed. Ointments and other external agents are often used. They not only eliminate pain, but also improve blood circulation and tissue trophism.
Physiotherapy for arthrosis of the acromioclavicular joint:
- Massage.
- Electrophoresis.
- Magnetotherapy.
- Laser therapy.
- UFO.
- Sinusoidal currents.
Surgery is a rare case. But if it is required, arthroscopic resection of the acromion is most often performed.
Rehabilitation after joint surgery
In order for the recovery process to be faster and not accompanied by complications, after the operation, the limb must remain motionless for a long time. Next, the patient must undergo a course of physiotherapy, as well as exercise therapy. In addition, massage is prescribed. Of the physiotherapeutic procedures, UHF is most often used. In this case, the damage area is affected by fields of different frequencies. Metabolism normalizes, damaged ligamentsare restored, puffiness subsides, tissue healing is accelerated. Massage improves lymph outflow, reduces swelling, helps restore blood circulation. There are no contraindications for massage. This procedure is allowed when recovering from various injuries, as it facilitates the process of developing muscles that have atrophied after prolonged immobility.
