AC Joint Sprain – Emily Georgopoulos
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
