Where is the AC joint?

The acromioclavicular joint is where the acromion of your scapula meets the clavicle bone on the front of your chest/shoulder. The AC joint is most usually injured from direct trauma (eg car accident) or a fall onto the area while the arm is by the side. This can happen in most contact sports eg rugby.

Signs and symptoms

• Pain and tenderness over the joint
• Pain may radiate into the neck and shoulder muscles and even down the arm
• Difficult activities: reaching across body, putting arm overhead, reaching behind body, carrying
• Pain during the night affecting sleep

Grading of AC joint sprains

Grade 1: slight sprain of ligaments around joint

Grade 2: acromioclavicular ligament is torn, other ligaments intact, clavicle will displace superiorly to the acromion which can be felt on palpation

Grade 3: acromioclavicular and coracoclavicular ligaments are torn

Grade 4: grade 3 injury with coracoclavicular ligament torn off the clavicle with some displacement of the clavicle

Grade 5: a grade 3 injury with greater displacement of the clavicle posteriorly

Grade 6: a grade 3 injury with dislocation of the clavicle

Diagnosis

X ray and ultrasound imaging is required for diagnosis

Initial management

• Analgesia – pain relief by either over the counter or GP prescribed medication can be of use to reduce pain and to help with sleeping at night
• Taping – to help rest and protect the area while providing some support
• Rest – resting from aggravating activities and from sport

Physiotherapy management

• Protect the shoulder – this may be done using taping and also guidelines on sports/activities to avoid
• Soft tissue release of surrounding muscles – you will find your neck, mid back and arm will become very tight. By relaxing these it helps to prevent further issues and helps to encourage normal range of motion sooner
• Postural advice – to help place the shoulder in the most optimal position for healing and function
• Exercise advice – stretches and strengthening exercises to help progress range of motion and strengthen the muscles surrounding the AC and shoulder joint

Surgical management

For a grade 3 or high AC sprain, surgery may be required. This requires a referral from your GP.

Recovery time frame will vary depending on grade of injury. Typically

Grade 1 and 2: two to four weeks recovery

Grade 3: six – eight weeks recovery

Grade 4 and 5: after surgical intervention, four to six months

Return to sport is considered when there is

• Full and pain free range of motion of the affected shoulder
• Normal strength in all positions for the shoulder, particularly flexion and horizontal abduction/adduction
• Sport specific skills can be performed pain free
• Tape may be used to help support the joint

Emily Georgopoulos

POGO Associate Physiotherapist