Biography/Disclosures
Biography: Dyer is a NCCPA-certified physician assistant who practices at Emerge Orthopedics in Chapel Hill, North Carolina, and Durham, North Carolina.
November 25, 2019
1 min read
Save

BLOG: Case study 52-year-old right hand-dominant woman

Biography/Disclosures
Biography: Dyer is a NCCPA-certified physician assistant who practices at Emerge Orthopedics in Chapel Hill, North Carolina, and Durham, North Carolina.
You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

by Sam Dyer, PA-C, MHS

A 52-year-old right hand-dominant woman was seen in the orthopedic clinic after sustaining a fall from a horse. She had increased shoulder pain and loss of motion. She reported pain primarily along the superior aspect of her shoulder with no numbness or tingling in the arm or hand. She had no loss of grip and was distal neurovascular intact. She did notice a “hard knot” over the posterior/superior shoulder that was painful.

The initial radiographs are shown here:

 
 
Source: Sam Dyer, PA-C, MHS

 

The diagnosis was discussed with the patient and the decision was made for surgery. What is the diagnosis?

Discussion

This patient has an uncommon acromioclavicular (AC) separation that is actually best determined by the trauma axillary view (see arrows). Notice the posterior position of the distal clavicle with relation to the AC joint? It is a grade IV separation where the clavicle has penetrated the trapezius posteriorly. She had open reduction with internal fixation with repair of the AC ligament and reconstruction of the coracoclavicular ligaments with a hamstring allograft.