ABSTRACT
Treatment requires resuscitation and then reconstruction of the vascular, neurological and musculoskeletal injuries. A fall on the shoulder strains or tears the acromioclavicular ligaments, and upward subluxation of the clavicle may occur; more severe injury also tears the coracoclavicular ligaments, resulting in complete dislocation of the joint. Closed reduction can sometimes be achieved by lying the patient supine with a sandbag between the shoulder blades and then pulling on the arm with the shoulder abducted and extended; the joint reduces with a snap. The patient supports the arm with the opposite hand and is loath to permit any kind of examination. The lateral outline of the shoulder is flattened and a small bulge may be seen and felt just below the clavicle. When the patient is fully awake, active abduction is gently tested to exclude an axillary nerve injury or rotator cuff tear. The arm is then supported in a sling.
