Type:
Educational Exhibit
Keywords:
Musculoskeletal joint, Ultrasound, Plain radiographic studies, CT, Efficacy studies, Staging, Trauma
Authors:
H. Thalagala, J. Hocking, A. Coulthard; QLD/AU
DOI:
10.1594/ranzcr2016/R-0072
Background
The Rockwood classification system of AC joint injury was introduced in 1984,
which graded AC joint injuries into six categories.(1,
2)
Current best practice of AC joint injury management is based on this system.(3) Patients are either conservatively or surgically managed depending on what class of AC joint injury they are diagnosed with.(4,
5) Classes I-II are managed conservatively,
classes IV-VI are managed surgically and class III injuries are managed on a case-by-case basis.
Research into the accuracy of AC joint injury classification has shown consistently that the addition of either; alternative views or adjunctive imaging often significantly alters the injury class that was originally diagnosed by the treating doctor.(6-10)
Typically the AC joint is analysed with plain radiography using an antero-posterior (AP),
axillary,
transcapular Y and/or Zanca view.(6,
11,
12) The Zanca view is an AP with 15-degree cephalic tilt; it is often done in lieu of the AP views as it removes overlying structures.
The addition of bilateral and weighted views has been shown by researchers to affect the classification of injury resulting in a change of management.(6,
11) Stress views,
such as Alexander or Basamania,
can also be used to assess for stability of the joint.(13)
Alternate imaging modalities have also been explored.
This includes MRI,
traditional CT scanning and the novel method of 4D CT.(8,
9,
14) The patient’s management plan and/or injury class were often changed when using these alternative methods.
Furthermore,
ultrasound sonography of patients undergoing dynamic shoulder movements has allowed clinicians to appreciate extra details of the condition of soft tissues that could affect management.(7)