AC Joint Injuries | Plenty Physiotherapy, Bundoora

AC Joint Injuries Document 

An ACJ injury is to the acromioclavicular joint (where the clavicle meets the acromion of the  scapula). The AC joint forms part of the shoulder structure.  is the point at which the lateral end of the  clavicle (collarbone) meets with the part of the  scapula (shoulder blade) called the acromion  process. It can be identified by sight and touch as  the pointy protrusion near the top, outer edge of  the shoulder. The joint is surrounded by a joint capsule and  receives additional support from the  acromioclavicular and coracoclavicular  ligaments (the coracoclavicular ligament is made  up of the trapezoid and conoid ligaments). These  ligaments are commonly damaged in AC joint  injuries. Mechanism of Injury: - Commonly from a direct fall onto the point of the shoulder (e.g., contact sports,  cycling, falls onto the shoulder side). - Alternatively, an AC joint injury may result from an upward force transmitted  through the humerus (upper arm bone), such as a fall that impacts directly on  the wrist of a straightened arm. Typically, the shoulder is in an adducted (close  to the body) and flexed (bent) position when this occurs. - Can also occur from an outstretched hand mechanism. Classifications: - Grade I (Mild): Tenderness and discomfort on palpation and movement. Partial  damage to the joint capsule and AC ligament. Usually no visible bump. Return to  play – up to 3 weeks. - Grade II (moderate): Complete rupture of the acromioclavicular ligament and  partial tear of the coracoclavicular ligament. This allows the clavicle to move  upward, creating a visible bump. Pain is more severe and shoulder movement is  restricted. Return to play – minimum 4 to 6 weeks. - Grade III (Severe): Complete rupture of both the acromioclavicular and  coracoclavicular ligaments. The bump is more pronounced due to complete  dislocation of the AC joint. Return to play – dependent on management (e.g.  surgery). Symptoms: Localised pain on top of shoulder, pain with cross-body adduction,  overhead movements, or lifting and swelling or visible step deformity (higher grades). Contributing Factors: A) Trauma: Contact sports (rugby, AFL, wrestling), cycling crashes, snowboarding. B) Occupational: Heavy manual labour with overhead lifting. C) Recurrent instability/prior AC Joint injury: Previous AC injuries predispose to  chronic weakness and arthritis of the joint and ligaments.  Treatment/Management: 1) Acute management: a. Immobilisation in sling (1–3 weeks, varies by protocol and age/injury  severity).  b. Avoid positions of dislocation and pain aggravation (e.g., Hands behind  back, horizontal adduction and end or range flexion) c. Ice can help with pain and swelling management  d. Medication: Pain analgesics  aging: X-ray (and or MRI) to rule out fracture/extent of ligamentous  injury if required.  1) Physiotherapy/rehab: Exercises targeting the muscle imbalances and poor  biomechanical patterns above and below the shoulder joint will aid in proper  shoulder movements and optimal loading. Specifically targeting a gradual range  of motion program with the progressive tolerated strengthening of the rotator  cuY, deltoid and scapular stabilisers. Overtime, building this strength training  into more power and plyometric shoulder exercises +/- specific return to sport  activities. Your physiotherapist will also provide education and guides to proper  warm-ups of the shoulder to prevent shoulder recurrent dislocations going  forwards. Manual therapy such as soft tissue work can be utilised to help with pain  reduction and shoulder mobility and stiYness. Taping by your physiotherapist can aid in comfort, protection and catalysing  healing.  2) Surgical/Medical intervention: The use of an X-ray (to rule out fracture) and/or  MRI (to assess further pathology). In some presentations if conservative  management is not responding as expected, the patient is having recurrent AC  joint pain/instability, the patient is in a “high risk population” or the presentation  is severe as per the imaging results, it may warrant specialist opinion from a  sports doctor or a surgeon (+/- subsequent surgery). This can be organised and  recommended by your physiotherapist. It is important to note that conservative  management will help many individuals to improve their symptoms and return to  their daily tasks and leisures.