Shoulder Injury

Depending on the severity of the ligament damage, acromioclavicular sprains usually are classified into three grades:

• Grade I — The acromioclavicular ligament is partially torn but its companion ligament, the coracoclavicular, is uninjured, so the acromioclavicular joint remains tightly joined.
• Grade II — The acromioclavicular ligament is completely torn and the coracoclavicular ligament is partially torn. In this case, the collarbone typically angles slightly out of place.
• Grade III — Both the acromioclavicular ligament and the coracoclavicular ligament are completely torn, and the collarbone separation is obvious.

Sternoclavicular Joint Sprain

• The sternoclavicular joint is located where the inner end of the collarbone meets the breastbone.
• Because the sternoclavicular joint is even more tightly connected than the acromioclavicular joint, sternoclavicular injuries occur very rarely, only about one-fourth as often as acromioclavicular injuries.
• When the sternoclavicular joint is sprained, it is often when a driver’s chest strikes the steering wheel during an auto accident, or when a person is crushed by an object.
• In athletes, sternoclavicular sprains sometimes are seen among football players and rugby players after a direct kick to the breastbone or some sideways tackles that impacts the back or side of the shoulder.

Sternoclavicular sprains are graded from I to III:

• Grade I— The tears in the joint ligaments are mild and microscopic. The sternoclavicular joint remains tightly connected.
• Grade II — Ligaments between the collarbone and breastbone are visibly torn, but ligaments between the collarbone and ribs remain intact, so the joint is slightly deformed, but retains some connection.
• Grade III — All ligaments sustain severe damage, so the sternoclavicular joint is separated or deformed, and the collarbone is clearly displaced from its normal position.

Symptoms

• If you have a Grade I acromioclavicular sprain, you will have slight swelling and tenderness at the outside tip of your collarbone.
• You will have mild pain when you move your arm or shrug your shoulder.
• In more severe acromioclavicular joint sprains, swelling will distort the normal contour of your joint, and the area will be very tender.
• You will feel significant pain when you try to move your arm or when your doctor or athletic trainer touches the joint while examining it.
• Symptoms of sternoclavicular sprains are similar to those of acromioclavicular sprains, except swelling and tenderness are located near the midline of the chest.

Prevention

• Wearing protective padding during high impact sports might offer some protection against sprains and other shoulder injuries.
• If you have had a sprained shoulder, you may help to prevent injuring it again by practicing shoulder strengthening exercises recommended by your doctor or physical therapist.

Treatment

Treatment depends on the type of sprain and its grade.
Acromioclavicular joint sprains

• In Grades I or II sprains, the injured shoulder is treated with rest, ice and a nonsteroidal anti-inflammatory drug, such as ibuprofen (Advil, Motrin and others) to relieve pain and swelling. The arm is placed in a sling for one to three weeks.
• For most Grade III sprains, the sling is worn for four weeks. Some Grade III sprains may require surgery, particularly in very young people, in adults who work at jobs that require heavy lifting, or in people whose collarbone is displaced more than 2 centimeters (about 1 inch) out of its normal position.

Sternoclavicular joint sprains

• Grade I sprains are treated with ice, nonsteroidal anti-inflammatory drugs, and a sling for one to two weeks.
• InGrade II sprains, the sling is worn for three to six weeks.
• Grade III sprains require a procedure called closed reduction. This is when the displaced collarbone is carefully slipped back into place after the person has received anesthesia or sedating medicines. Once the collarbone is back in its normal position, the injured shoulder is immobilized using a “clavicle strap” or figure-of-eight splint, along with a sling for four to six weeks.

Prognosis

The outlook depends on the type of sprain and its grade:
Acromioclavicular joint sprain

• The long-term prognosis for Grade I and Grade II injuries is good.
• However, 30% to 40% of people with this type of joint sprain notice some minor lingering symptoms, such as a clicking sensation in the shoulder or pain during pushups or other exercises that strain the shoulder.
• In studies of athletes who had Grade III sprains, both surgical and nonsurgical treatments gave good results, with about 90% regaining full range of motion without pain.

Sternoclavicular joint sprain

• After proper treatment, about 70%to 80% of people with Grade I or Grade II sprains are pain free and able to participate in normal athletic activities.
• The remaining 20% to 30% of people have occasional pain in the affected shoulder, as well as some limitations in how they perform athletically.
• People with Grade III sprains usually have a good long-term prognosis, with normal range of motion at the shoulder and little pain or disability. In some cases, however, the person has mild discomfort in the shoulder during
• activities that require heavy exertion of the arm.