What bothers me is the fact that today O'brien said that Savage will undergo
another MRI. (The initial one Friday revealed no fractures). Plain xrays usually can make the proper diagnosis of AC joint injury type. An MRI, though, essentially never downgrades the extend of the injury. In fact, the MRI upgrades the severity of a type I injury in 50% of cases and 20% in type II cases. Since this has already been classified as a "severe" sprain, and now an additional MRI is called for, I believe that the Texans have inadvertently revealed that Savage is dealing with a type III sprain............and will
now be running an MRI arthrogram due to concern over associated injury(ies) such as labrum tears and/or intra-articular cartilage damage, which would not be necessarily identified by a standard MRI. (Remember when I pointed out the the Texans unknowingly missed Ed Reed's hip labrum tear which led to his necessitating major hip surgery, simply because they initially failed to order an MRI arthrogram in addition to the standard MRI?)
As a point of interest, a recent paper presented in March of this year at the annual meeting of the
American Academy of Orthopaedic Surgeons demonstrates a surprisingly high incidence of the associated injuries I mentioned above (even in lesser than type III AC joint injuries). (Do not become confused because you see type IV,V and VI referred to in this presentation........they do exist in the newer classification of AC joint injuries, but I did not want to make things any more complicated for you than it already may be to understand. The more basic type I, II and III classification will serve your fundamental understanding of this subject well.)
Abstract :
INTRODUCTION: Acromioclavicular (AC) joint separations are common in orthopaedic practice and frequently associated with high-impact forces to the shoulder. Despite the common occurrence of AC separations, little information is available about the incidence of intra-articular injuries that may also result from the high impact forces acting on the glenohumeral joint. Our hypothesis is that intra-articular shoulder pathology is common with acromioclavicular joint injury.
METHODS: Sixty-six patients (12 female, 54 males; ages 16-85 (average 40.5)) were clinically diagnosed with either an acute or chronic acromioclaviclar joint dislocation prospectively. Each patient then underwent an magnetic resonance arthrography (MRA) to evaluate intra-articular pathology. Besides clinical and radiographic results, intra-operative findings were recorded from 21 patients that also underwent subsequent shoulder arthroscopy.
RESULTS: In this prospective case series, there were 66 patients who were included (52 acute AC joint dislocations, one acute on chronic, and 13 with chronic AC joint dislocations). The most common mechanism of injury was a fall (25%), biking (13.7%), football (12.1%), or motor vehicle accident (12.1%). The degree of AC joint injury ranged from grade I (16.67%), grade II (50%), grade III (27.27%), and grade IV (6.06%) AC separations. MRA demonstrated associated intra-articular pathology in 47/66 patients (71.2%) overall and included (44/66, 66.7 %) superior labrum anterior posterior (SLAP) tears (all SLAP tears Type 1, 2, and 3), (12/66, 18.2%) anterior labral tears, 3/66 (4.5%) posterior labrum tear. Labral injuries occurred in 6/11, 54.55% of grade I, 22/33, 66.67% of grade II, 13/18, 72.2% of grade III, and 4/4, 100% grade IV AC separations. Coracoclavicular ligament reconstruction was performed in 4/66 (6.1%) patients. Symptomatic labral pathology required treatment in 19/66 (28.7%). Intraoperative evaluation confirmed the intra-articular injuries seen on preoperative MRA in 19/21 surgical cases (91%).
DISCUSSION AND CONCLUSION: This is the first study that systematically investigates the incidence of intra-articular shoulder injuries associated with acromioclavicular joint separations. The results demonstrate a very high rate of glenoid labral injury and suggests that the incidence increases with the severity of the AC separation. This study suggests that labral injury should be considered as a cause of acute or persistent symptoms in patients with AC separations. Keywords: Labral tears, acromioclavicular joint dislocations, SLAP tears, shoulder trauma, shoulder instability.
SUMMARY: We report a high incidence of concomitant intra-articular glenohumeral joint injuries associated with AC joint separations that suggests that careful examination of the entire shoulder girdle should be performed when evaluating AC joint injuries.
Keep in mind that in an NFL QB, any one of these potentially
associated injuries may independently become indications for surgical intervention in themselves.