Return to play after nonoperative management for a severe type III acromioclavicular separation in the throwing shoulder of a collegiate pitcher

Abstract

Background. Treatment of type III acromioclavicular (AC) separations is controversial, especially in the dominant shoulder of a high-level throwing athlete. This case report describes the return to play after nonoperative management of a collegiate baseball pitcher with a severe type III AC separation in his throwing shoulder. Hypothesis/purpose. Case report of return to play with nonoperative management of a type III AC separation in the throwing shoulder of a collegiate pitcher. Study design. A case report of a single patient. Methods. Prospective data were recorded in the case of a collegiate pitcher who suffered an acute injury to the dominant shoulder, resulting in a severe type III AC separation. He was initially treated with a figure-of-8 brace and a sling. Postinjury, strengthening of the wrist, hand, and elbow began at 3½ weeks, and shoulder range of motion (ROM) and a periscapular strengthening program began at 6 weeks. At 2 months postinjury, a deformity was still present, but the athlete was pain free, with full shoulder ROM and strength without tenderness at the AC joint. Formal physical therapy was initiated to include an accelerated interval throwing program. Results. At 12 weeks postinjury, the athlete was pitching asymptomatically, and gradually returned to regular play. At 6 months and now through 24 months postinjury, the athlete reported full strength, full ROM, and return to his previous level of throwing and velocity without complication. He volunteered that he was 100% satisfied with the result, and feels he is the same pitcher as, if not stronger than, prior to this injury. Conclusions. This case demonstrates a collegiate baseball pitcher who returned to his preinjury level of pitching with nonoperative treatment of a severe type III AC separation.

Keywords:

• Acromioclavicular separation
• nonoperative treatment
• throwing athlete

Acknowledgements

The authors would like to acknowledge Allyson Sandago MPH, ATC. and Amanda Arnold PT, DPT, OCS, CSS, for their significant contributions to this paper.

Declaration of interest: Scott T. Watson, MD, has no conflict of interest to declare. Douglas J. Wyland, MD, has received general research funding from DJO Surgical, Arthex, Arthrosurface, Smith & Nephew, Breg, ArthroCare, Pacira, and Neurotech.