The diagnosis of acromioclavicular joint injuries is made clinically. The typical mechanism of injury, as well as tenderness and deformity at the acromioclavicular joint, is confirmatory. Radiographs are useful for identifying other fractures and determining the severity of injury. Acromioclavicular radiographs should specifically be ordered because they require only one-third to one-half the penetration of standard shoulder films. Shoulder technique will overpenetrate the acromioclavicular joint, and small fractures may be missed. Although standard acromioclavicular radiographs are generally sufficient, an axillary view is required to identify posterior clavicular dislocation (type IV, see below). Routine use of stress radiographs has been standard practice. Recently, however, Bossart and colleagues have called this practice into question. Their study suggests that stress radiographs are of low yield and that their routine use should be abandoned. Although some agree, others disagree, citing occult type III (see below) injuries that can be unmasked only with stress radiographs.
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