WASHINGTON — A new Canadian study suggests too many patients might be undergoing surgery to fix a severely messed up acromioclavicular joint — one of the most common shoulder injuries.
Researchers at St. Michael’s Hospital in Toronto followed 83 patients with moderate to severe joint dislocations at the top of a shoulder. Forty had surgery involving plates and screws in the shoulder followed by rehabilitation, while the other 43 skipped the knife and received nonsurgical treatment only.
The study found those who did not have surgery and relied instead on wearing a sling and physical therapy healed just as well as those who had an operation.
But Dr. Ben Kittredge, a sports medicine orthopedic surgeon with OrthoVirginia, says the situation is not that straightforward, and treatment needs vary from patient to patient.
“It really depends on each individual situation,” Kittredge says.
He notes these injuries are most common in contact sports, where a shoulder can hit the ground hard. A high-school football player can get an AC dislocation, but so can a 45-year-old mom or dad participating in a weekend rugby or soccer match.
Kittredge says younger injured athletes tend to have different goals than casual weekend warriors, who are not in such a rush to get back on the playing field. Levels of pain also make a difference, as do the physical appearance of the injury.
One big advantage of surgery is that the joint is put back into place. Kittredge says some patients do not want the cosmetic deformity. But he says in most cases, they can take their time deciding if an operation is worth it.
“I don’t think you really lose much by waiting, because the operation you do down the road is not much different than the operation you do acutely,” he says. But after several months, if there is still pain and the patient is not doing well, surgery remains an option.
The authors of the Canadian study — published in the Journal of Orthopaedic Trauma — say surgeons should think twice before recommending surgery for any AC joint dislocation, regardless of the severity.
Kittridge says it’s OK to try other treatments first, but there are still cases where surgical intervention is warranted.
