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200
38

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Anatomy

Upper Limb

Question 218 of 239

A 75 year old lady presents to ED complaining of pain in her shoulder following a fall onto an outstretched hand. Imaging shows dislocation of the acromioclavicular joint. Which of the following ligaments were most likely damaged in this injury:

Answer:

The acromioclavicular joint is reinforced by two main ligaments; a small acromioclavicular ligament and a much larger coracoclavicular ligament.

Acromioclavicular Joint Dislocation

Anatomy / Upper Limb / Pectoral Region

Last Updated: 24th January 2019

Dislocation of the acromioclavicular joint may result from a direct blow to the joint, a hard fall onto the shoulder or from a fall onto an outstretched upper limb. In acromioclavicular joint dislocation the acromion is forcibly pushed inferiorly and medially with respect to the clavicle, and becomes more prominent.

Acromioclavicular Joint Dislocation. (Image by James Heilman, MD [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)], from Wikimedia Commons)

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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