Injuries to the ligaments are among the most common sports injuries. Many people are familiar with torn ligaments in the upper ankle joint. Less well known, but just as common, is shoulder ligament injury. What causes the so-called acromioclavicular joint dislocation and how it is treated.
It can happen to horse riders, cyclists and motorcyclists: They get off or fall off their horse or vehicle and want to catch themselves with their hands. A brief, painful moment: either the wrist is broken or the acromioclavicular joint – the joint between the collarbone and shoulder – is displaced. “The acromioclavicular joint is a weak point. If the arm is splayed and receives a sudden impact, the anterior pectoral muscle pulls the ball out of the joint,” explains Hans-Christoph Pape, Director of the Department of Traumatology, Prof. Dr. med. As a result, the capsule and ligaments of the acromioclavicular joint tear, in the worst case completely.
Surgery only necessary in severe cases
If the acromioclavicular joint is only slightly displaced, i.e. the ligaments are only strained or partially torn, there is no need for surgery. It is then sufficient to immobilize the arm in a splint for three weeks. The tissue scars and becomes firm again. However, if the joint is correctly displaced and the ligaments are torn, the outer lanyard will shift. In this case, we speak of the piano key phenomenon. “The collarbone is high. You can press it down slightly by hand, like a piano key,” explains Hans-Christoph Pape.
In this case, surgery must be performed. The ligaments are sutured and the collarbone is fixed to the shoulder joint. At the USZ, the so-called flip technique (TightRope) is used: First, a very fine hole is drilled in the clavicle and acromioclavicular joint. Then the surgeons use an extremely tight thread. “Such threads are also used for parachute jumping cloths, which contain metal,” explains Hans-Christoph Pape. Guide this through the two small holes. There is a small metal clip at the end of the thread, which then folds down. “Then we just have to tighten the thread and knot it neatly”. This technique is also used for ligament injuries to the ankle joint.
Short operation, small scar
The operation takes about 40 minutes and only leaves a small scar of about one centimeter. “We have been operating on acromioclavicular joint replacements at the USZ using this technique for around 10 years,” explains Hans-Christoph Pape. There are around 55 patients per year. A study led by Hans-Christoph Pape shows that most hospitals in Switzerland use this minimally invasive method. Plates are only used if there is a combined injury, i.e. if the ligament is torn and there is also a fracture. “This almost only occurs in high-energy and high-speed sports,” explains the clinic director. The kinetic energy of your own body, which track and field athletes use, for example, is not enough to break bones. This is why motorcyclists, e-bikers and downhill riders often suffer serious shoulder or knee injuries.
Increase training slowly
Shoulder injuries and other sports injuries cannot be completely prevented. However, it is an advantage if people who are active in sports do not increase their training too quickly. Hans-Christoph Pape speaks from experience: “The people who are most at risk are those who are untrained and training for a major sporting event within a short period of time. For example, you should prepare for a marathon for more than three months”. He therefore strongly recommends interval training. Studies have also shown that many sports injuries have a history. Mini-injuries are often already present, which can then lead to a major injury in the event of a sudden, major strain.
If you injure yourself anyway, it is important that a specialist takes a look at the injury. Even if nothing is broken, the joints may wear out after tendon injuries, for example. If the pain does not subside even weeks after an accident, it is definitely worth seeing a doctor.
Want to know more?
Shoulder injuries are treated at the USZ in the Department of Traumatology.
Study on different treatment strategies for acromioclavicular joint injuries : www.ncbi.nlm.nih.gov/pubmed/30904018.
