Podcast 563:  DC ACs

<p><strong>Contributor: Nick Hatch, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;"><span style="font-weight: 400;">An AC (acromioclavicular joint) separation in the shoulder is a common traumatic injury</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">XRs can help rule out other injuries as well as help with grading the injury</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">There are six different grades for AC separations:</span></li> <li style="list-style: none; display: inline;"> <ul> <li style="font-weight: 400;"><span style="font-weight: 400;">Grade I: is stretching of the AC ligament without disruption or displacement of the clavicle and recovers with time.</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">Grade II:  is partial tearing of the AC ligament with some displacement but will also heal with time.</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">Grade III: is a full separation with ligament rupture and may require surgery but is not always indicated. Surgery is more common in active patients.</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Grades IV, V, and VI are severe separations and all require surgery.</span></li> </ul> </li> <li style="font-weight: 400;"><span style="font-weight: 400;">Other ligament damage or tears, like a slap injury, can mimic an AC separation and often require surgery but should remain on the differential diagnosis when working up shoulder trauma.</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Setting expectations is key. Patients with a grade 1 or 2 separation should expect 6+ weeks of limited range of motion and up to 12 weeks until return to full function.</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Cosmetically there may be a persistent bump on the shoulder.</span></li> </ul> <p><strong>References</strong></p> <p><span style="font-weight: