Dr. Selene Parekh
Mets Tatis on the DL List with Shoulder Injury
The Mets announced that Fernando Tatis has been placed on the disabled list for 15 days with a right shoulder AC joint sprain. What is this?
ANATOMY
The shoulder is a complex structure, relying on a combination of bones, ligaments, and tendons to give it stability. One of these components is the acromio-clavicular (AC) joint. The acromion projects off the shoulder blade (the scapula). You can feel the acromion as the bone on the outer most part of the top of the shoulder. The clavicle is also known as the collar bone. Where these two bones meet is known as the AC joint.
There are two ligaments that help to stabilize the AC joint: the AC ligament and the coraco-clavicular (CC) ligament. Injury to these structures can lead to one of six AC injury patterns:
Type I -sprain of the ligaments without a tear of either.
Type II – AC ligament is torn, but CC ligament is not
Type II – AC and CC ligaments are torn, with a small bump seen
Type IV – the clavicle pierces the muscle behind the shoulder
Type V – AC and CC ligaments are torn, with a larger bump seen
Type VI – the clavicle mover downward
CAUSES
An AC separation or sprain is usually the result of a direct trauma to the joint. This can occur in the form of a direct blow to the shoulder, as in football or rugby, or with a fall on an outstretched hand.
SYMPTOMS
Patients usually complain of immediate pain, swelling, and bruising in the shoulder. There is usually pain with any motion of the shoulder, but particularly with an upward motion of lifting the arm. There may be a visible bump on the tip of the shoulder.
A good physical exam and xrays are needed to evaluate this injury. Xrays will allow a physician to know what type of AC injury you have sustained.
WHEN TO SEK MEDICAL CARE
If you suspect that you have this type of injury, you should see a medical professional within hours of the injury.
TREATMENT
Nonsurgical treatments are adequate for patients with Type I, II, and III injuries. The treatment typically involves a period of time in a sling, for a few days. The sling can be stopped once range of motion is painless. Physical therapy is then started. Nonsteroidal anti-inflammatory medications can be used to help with the pain.
Surgical procedures can be used for type III, IV, V, and VI injuries.
OUTCOMES
Patients with type I, II, and III injuries typically do very well, with little long-term problems.
RETURN TO ACTIVITIES
From reports, it appears Tatis may have a type I or II injury. He should be back in the line up within 2 to 3 weeks.
VIDEO/ANIMATIONS
For a video animation of “Anatomy of the Shoulder”, please see the “Education” tab of my website. Click orthopaedics, then shoulder, then conditions, then Anatomy of the Shoulder.
Dr. P
All material published through this blog/website is for informational and entertainment purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Dr. Parekh and Duke University will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the discussions in this blog.
