Abstract
The Superior Shoulder Suspensory Complex (SSSC) comprises a bony and soft tissue ring including the clavicle, acromioclavicular (AC) joint, acromial process, glenoid fossa and process, coracoid process and coracoclavicular ligaments [1]. This complex is believed to have important biomechanical functions concerning shoulder stability and overall shoulder function, and connects the upper extremity via the clavicle with the axial skeleton [2]. Disruption of the SSSC at a single location due to a clavicle fracture, acromion fracture, or ACjoint dislocation with intact coracoclavicular (CC) ligaments, is a common injury often treated conservatively as the stability of the SSSC is still warranted, if no other indication for operative therapy exists. Double disruption of the SSSC is a rare injury thought to destabilize the construct, and therefore operative repair of one or both of the involved structures is recommended [3-8]. Triple and quadruple SSSC disruptions have been reported, although they are even rarer. They most often result from high energy trauma events, which are very often accompanied by associated injuries of the ribs, spine, nerves and head [9-18]. The more parts of the SSSC are injured, the greater the instability of the shoulder girdle. Thus, almost all of these injury types are treated surgically. We report on the radiological and functional outcome of a quadruple SSSC disruption, which was successfully treated in a conservative manner and followed up for one year posttrauma.
Highlights
The Superior Shoulder Suspensory Complex (SSSC) comprises a bony and soft tissue ring including the clavicle, acromioclavicular (AC) joint, acromial process, glenoid fossa and process, coracoid process and coracoclavicular ligaments [1]
We report on the radiological and functional outcome of a quadruple SSSC disruption, which was successfully treated in a conservative manner and followed up for one year posttrauma
Multiple disruptions of the SSSC are rare, they may become more frequent in an ever-increasing aging, yet active population
Summary
The Superior Shoulder Suspensory Complex (SSSC) comprises a bony and soft tissue ring including the clavicle, acromioclavicular (AC) joint, acromial process, glenoid fossa and process, coracoid process and coracoclavicular ligaments [1]. The patient was hesitant to undergo any surgical intervention almost three weeks after the bicycle accident Both patient and physician agreed on conservative treatment involving assisted mobilization of the right shoulder under physiotherapeutic guidance with limited ROM (70° abduction/ flexion without resistance/weightlifting) for three weeks, followed by free active ROM mobilization without resistance/ weightlifting for an additional six weeks. At 6-weeks post-trauma, the patient remained pain free with 80° active abduction/flexion, 20° external rotation, and internal rotation at the L3 level. By the 6-month post-trauma period, the patient achieved active ROM of 100° abduction, 120° forward flexion, 80° external rotation, and Th12 level internal rotation. Increasing fracture consolidation at the coracoid base and scapula neck as well as progressive fracture healing at the dorsal acromion was observed on the 1-year radiographs (Figure 3d). Because the patient continued to be completely unrestrained with his right shoulder, in his daily activities of biking and hiking as well as his pain free status even under load, further CT examinations were unnecessary and declined by both physician and patient
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