The x-ray indicates that this patient suffered a type III acromioclavicular joint separation with disruption of the acromioclavicular and coracoclavicular ligaments—a complete tear of the AC joint. Coracoclavicular ligament disruption is noted by the elevation of the distal clavicle. AC disruption is represented by a widening of the AC joint space.
An axillary view of the shoulder is necessary in all type III injuries to rule out a type IV (unstable) injury. This would show posterior displacement of the clavicle and requires immediate referral to an orthopedist. Type III joint injuries are most often managed nonoperatively with rest, ice, sling, and analgesics, as was the case with this patient.
Acknowledgment: Case presented by Nahum Kovalski, BSc, MDCM
