Imaging and Management of Acromioclavicular Joint Dislocation

Initial Radiographic Assessment

Obtain a standard trauma shoulder series with at least three views—anteroposterior (internal and external rotation), plus either an axillary or scapula‑Y view—to reliably evaluate AC‑joint injuries and avoid misclassification of concurrent glenohumeral dislocations. [1][2]

MRI without intravenous contrast is the preferred advanced modality for acute AC‑joint injuries, demonstrating 97 % accuracy, 96 % sensitivity, and 98 % specificity for detecting ligamentous and soft‑tissue pathology. 3
MRI simultaneously assesses rotator‑cuff integrity, osseous contusions, AC‑joint sprains, and capsular/ligament tears, providing a comprehensive view of injury extent. 3
The presence of an acute joint effusion permits adequate evaluation without the need for contrast administration. 3
MRI is superior for visualizing extra‑articular soft‑tissue injuries (e.g., surrounding musculature and fascia). 3

Ultrasound offers limited additional value for AC‑joint injuries, being useful primarily for isolated rotator‑cuff tear assessment. 3

Non‑contrast CT is valuable for delineating complex comminuted fractures and for characterizing associated scapular fractures when plain radiographs are inconclusive. [1][3]

Absolute indications for operative treatment include Rockwood type IV (posterior displacement), type V (severe vertical displacement with extensive soft‑tissue damage), and type VI (inferior displacement). These unstable patterns warrant surgical stabilization. 1
Acute surgical management is recommended for the aforementioned unstable types (IV, V, VI) to restore joint alignment promptly. 1

While specific functional criteria lack consensus, time‑based milestones are most frequently reported, with the majority of studies citing a return‑to‑play window of approximately 5–6 months after operative or non‑operative management. (Strength of evidence not explicitly graded in source.)

All facts above are derived from peer‑reviewed guidelines and studies cited as indicated.