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Acute Rockwood type III acromioclavicular joint dislocation — MSRA MCQ

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ModerateShoulder InjuriesAcute Rockwood type III acromioclavicular joint dislocationMSRA

A 29-year-old electrician is reviewed in general practice 5 days after falling directly onto the point of his right shoulder during a mountain-bike accident. Emergency-department radiographs excluded fracture and were reported as a Rockwood type III acromioclavicular joint dislocation. He has focal acromioclavicular joint tenderness and a persistent prominence of the lateral clavicle. He can actively elevate the arm to 110 degrees, limited by pain. Distal pulses, sensation and power are normal. There is no skin tenting, glenohumeral deformity, neck pain or dyspnoea. He is concerned that the deformity and his manual occupation mean that he needs immediate surgery. What is the most appropriate management now?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Continue non-operative management with analgesia, a sling for comfort, pain-limited gentle shoulder mobilisation and routine fracture-clinic or physiotherapy follow-up

Explanation lettering: B = shown as A · D = shown as B · E = shown as D · A = shown as E

This is an uncomplicated acute Rockwood type III acromioclavicular joint injury. The direct impact mechanism, local acromioclavicular tenderness and prominent lateral clavicle support this diagnosis; imaging has already excluded fracture. Preserved distal neurovascular findings, absence of threatened skin and retained active elevation argue against an emergency complication requiring immediate operative escalation. UK NHS fracture-management guidance supports analgesia, a sling for comfort rather than rigid immobilisation, and gentle shoulder movement as pain improves. It also explains that the clavicular prominence may persist without impairing function. The patient’s manual work affects advice about graded return to lifting and work, but does not itself establish an indication for urgent reconstruction. Current systematic-review evidence specific to acute Rockwood III injuries found no important functional advantage of surgery over conservative treatment, although surgery improves radiographic reduction and introduces surgical complications. B is plausible because high functional demand can justify specialist discussion if disabling symptoms persist, but not urgent surgery in this presentation. C is inappropriate because AC joint reduction with strapping does not provide reliable durable alignment. D unnecessarily delays rehabilitation and increases stiffness risk; the sling is for comfort. E would be appropriate if there were a seizure or electrical-injury mechanism, a fixed restriction of external rotation, or glenohumeral deformity suggesting posterior dislocation, none of which is present.

Reference: NHS Lothian Patient Information Sheet – 10B: AC Joint Injury (Approved July 2025; review due July 2028) — https://rightdecisions.scot.nhs.uk/media/jgcaidpl/10b-ac-joint-injury.pdf Surgical vs conservative: what is the best treatment of acute Rockwood III acromioclavicular joint dislocation? A systematic review and meta-analysis (2025) — https://pubmed.ncbi.nlm.nih.gov/40071962/