Radiological Findings

The patient is a 37-year-old male who presented due to a shoulder collision injury. The X-ray images reveal:

• Significant widening of the acromioclavicular (AC) joint, approximately 1.0 cm.
• Widening of the coracoclavicular (CC) space to about 2.0 cm, exceeding the normal upper limit (usually no more than 11–13 mm).
• No obvious fracture lines involving the acromion or distal clavicle, but there is malalignment in the vertical positioning of the AC joint.
• Mild swelling of the surrounding soft tissue, with no significant bony fragments or loose bodies observed.

Overall, these imaging findings are consistent with AC joint separation, showing marked structural disruption and abnormal alignment in the coracoclavicular ligament region.

Possible Diagnoses

Based on the clinical history and imaging findings, the possible diagnoses or differential diagnoses include:

• AC joint sprain or Grade I/II AC joint separation: May involve only the acromioclavicular ligament or partial coracoclavicular ligament injury, typically without significant CC space widening.
• Grade III AC joint separation (Tossi III): Complete tears of both the AC and coracoclavicular ligaments. Imaging findings show a markedly widened AC joint with an increased CC space.
• Distal clavicle fracture or other structural injury to the AC joint: Although the imaging does not clearly show a fracture line, subtle fractures or traumatic bony changes should be ruled out.
• Chronic distal clavicle osteolysis (e.g., rheumatoid arthritis, infection, or metabolic bone disease): Such conditions can also cause widening of the AC joint space, often accompanied by a chronic medical history and other characteristic imaging changes.

Final Diagnosis

Considering the mechanism of injury (fall or collision to the shoulder), the radiographic findings (marked widening of both AC joint and CC distance), and the clinical symptoms, the most likely diagnosis is:

Grade III AC joint separation (Tossi III AC joint injury).

If further confirmation is needed, additional physical examination, contralateral comparison X-rays, or MRI can be utilized to confirm complete ligament tears.

Treatment Plan and Rehabilitation

Treatment for Grade III AC joint separation remains somewhat controversial. Typically, the treatment options include:

• Conservative treatment: Some patients can be managed with a sling or shoulder brace immobilization, along with analgesics and anti-inflammatory medications, to limit external stress on the shoulder and allow ligament healing through scar formation. This approach is suitable for patients who can tolerate the pain, have relatively low functional demands on the shoulder, or are otherwise stable.
• Surgical treatment: For individuals such as professional athletes or those requiring a high level of shoulder function, or in cases with significant deformity and severe functional impairment, ligament reconstruction or fixation surgery may be performed. Surgical methods include wire fixation, ligament reconstruction, or hook plate fixation, among others.

Rehabilitation and Exercise Prescription Recommendations:

• Acute Phase (first 2–3 weeks): Focus on shoulder girdle immobilization and pain reduction. Avoid large ranges of shoulder motion; perform gentle passive joint exercises in a non-weight-bearing setting, under professional guidance.
• Recovery Phase (3–6 weeks): Gradually initiate active range of motion training. Possible exercises include:
  • Shoulder flexion, abduction, and rotation within a comfortable range; gradually increase the range without provoking significant pain.
  • Low-intensity resistance band training with slow, controlled movements, progressively increasing resistance.
• Functional Strengthening Phase (6–12 weeks): Enhance full-range shoulder motion and strengthen the muscles:
  • Gradually increase resistance using bands or light dumbbells (starting at around 1–2 kg) to strengthen the deltoid, supraspinatus, and scapular stabilizers.
  • Introduce closed-chain upper limb exercises (e.g., modified push-ups), ensuring joint stability and absence of significant pain.
• Exercise Progression and Return to Daily Activities/Sports:
  • Follow the FITT-VP principle: adjust Frequency, Intensity, Time, Type, and Volume/Progression in a gradual manner. Monitor shoulder function and pain weekly and modify accordingly.
  • Before returning to contact sports (such as basketball, soccer, or weightlifting), have a physician or physical therapist evaluate shoulder function and confirm adequate ligament healing.

Throughout the rehabilitation process, if the patient has fragile bone health or additional comorbidities, it is crucial to thoroughly assess cardiopulmonary function and joint safety. If necessary, reduce training intensity and increase protective measures.

Disclaimer: This report is based solely on the provided clinical history and imaging information for reference purposes and does not replace an in-person consultation or professional medical advice. Specific diagnosis and treatment should be determined by a licensed medical institution or physician in conjunction with clinical examination, laboratory tests, and other relevant assessments.