The coracoclavicular ligaments are strong connective tissues in the shoulder, contributing to its stability and movement. They help keep the shoulder girdle aligned, enabling a wide range of arm motions. Understanding these structures is important for comprehending how the shoulder functions and what happens when injuries occur.
Understanding the Coracoclavicular Ligaments
The coracoclavicular ligament connects the clavicle (collarbone) to the coracoid process, a hook-like projection of the scapula (shoulder blade). It comprises two parts: the trapezoid and conoid ligaments. The trapezoid ligament is positioned towards the front and side; the conoid ligament is behind and towards the middle.
These two parts are separated by fat or a bursa, a small fluid-filled sac that reduces friction. Together, these ligaments provide vertical stability to the clavicle, preventing excessive upward movement relative to the scapula. This arrangement helps maintain the proper alignment of the acromioclavicular (AC) joint, even though the coracoclavicular ligaments do not directly cross it. They also limit excessive rotation of the clavicle and scapula, while allowing necessary movements like retraction and protraction.
Common Coracoclavicular Injuries
Coracoclavicular ligament injuries most often occur as part of an acromioclavicular (AC) joint separation, also known as a shoulder separation. These injuries frequently result from a direct fall onto the shoulder or forceful impact, common in contact sports like football or cycling. The severity of an AC joint separation, and thus coracoclavicular ligament involvement, is graded.
A mild Grade I injury might involve only a sprain of the AC ligaments with no coracoclavicular ligament damage. A Grade II injury includes a complete tear of the AC ligaments and a partial sprain or tear of the coracoclavicular ligament. In a Grade III injury, both AC and coracoclavicular ligaments are completely torn, leading to noticeable clavicle displacement and a visible shoulder bump. Patients experience moderate to severe pain, swelling, and tenderness at the top of the shoulder. Arm movement, especially overhead motions, becomes painful and limited, and the shoulder may feel unstable.
Managing Coracoclavicular Injuries
Management of coracoclavicular ligament injuries depends on their severity, with many cases responding well to non-surgical approaches. For less severe injuries, conservative management involves rest, ice, compression, and elevation (RICE) to reduce pain and swelling. Pain relief medication, such as NSAIDs or acetaminophen, may be recommended to manage discomfort.
Physical therapy plays a role in rehabilitation, focusing on restoring shoulder range of motion and strength. Initially, exercises may involve passive movements (therapist-assisted), progressing to active exercises as pain decreases. For more severe injuries, particularly complete tears and significant displacement, surgical intervention may be considered to restore AC joint stability. Following surgery, a structured rehabilitation program is implemented, involving a sling for protection, followed by gradual progression of range-of-motion and strengthening exercises over several weeks to months. A full recovery can take up to 6 weeks for Grade II separations and up to 12 weeks for Grade III separations.