Managing an AC Joint Injury
The acromioclavicular joint, otherwise known as the ACJ is a common injury among the sporting populations, particular those involved in contact sports such as rugby. I, myself have not suffered such an injury but during my time skiing recently my friend suffered a severe ACJ injury and this sparked my interest in writing this blog. This blog aims to educate people about ACJ injuries and when one might seek physio for treatment or require surgery.
What is the AC joint & What is its function?
The ACJ is located at the front of the shoulder where your collar bone meets your acromion (which is part of your shoulder blade). To have a clearer idea of where the AC joint can be found think where a bra or vest strap would go.
The AC joint is supported by 3 ligaments: acromioclavicular, coracoacromial and coracoclavicular. Ligaments help connect bone to bone and are important for keeping a joint (where 2 structures of bone are connected together) in its correct position. This joint allows the arm to move across the body and enables above head movements e.g. putting your seatbelt on or reaching for an item in the cupboard. Pushing, pulling and lifting are other important movements the AC joint allows us to do and these movements are required for every-day activities.
How does the AC joint get injured?
Normally injured through trauma or repetitive stress. An individual may suffer an AC joint injury through a collision e.g. a rugby tackle or from a fall. Another way to injure the AC joint can be from an indirect fall onto an outstretched arm. Depending on the significant of the fall this can sometimes cause a separation of the acromion and clavicle. An orthopaedic consultation with a referral for an x-ray would be required if someone is in a lot of pain and unable to move their arm following a fall. Consequently, this occurred to my friend while snowboarding and research has shown that this type of injury is one of the most common
amongst snowboarders (REF) due to the frequent amount of falls, particularly at novice level.
Classification of AC joint injuries
Clinicians would refer to a grading system, known as the Rockwood classification system, to determine the severity of an AC joint and ligament injury (REF). Injuries vary from a mild ligament strain e.g. type I to complete tear and deformity of the ligaments, causing major shift of the clavicle e.g. type IV (REF). An orthopaedic consultant or a specialist physiotherapist would be able to determine the grading of an injury following an x-ray, and physical examination.
When to seek medical attention?
If you feel or have:
– Moderate to severe pain on the top / front of the shoulder, which is aggravated by heavy lifting, pushing, pulling, overhead and across body movements.
– Swelling with or without bruising.
– Not able to move shoulder with reduced strength felt.
– Sometimes a hard, visible lump may be seen at the top of the shoulder, and this could indicate displacement of the collar bone.
These are the things to consider if suspect an AC joint injury.
Management of AC joint injuries
Research has shown that non-operative treatment is best suited for type I and II injuries, whereas types III-VI would require surgery (REF). However, this again is dependent on an individual’s presentation and the severity of the injury. Therefore, highlights the importance to see a clinician if you’re worried you may have this type of injury.
Example of management following a severe AC joint injury:
– Immobilised for 2-4 weeks, whereby the arm is put in a sling.
– Initial physio can commence following a period of immobilisation.
– This involves range of movement and strengthening exercises for the shoulder.
– These exercises can start of as simple movements and progressed as tolerable.
– The latter stage of rehab would focus on sport-specific movements if looking to return to a sport or functional movements which are difficult to perform.
Return-to-sport criteria following an AC joint injury (REF):
– Full shoulder range of movement which is painless.
– Full shoulder strength.
– Able to perform a pain-free shoulder press and bench press.
It is important to know that return-to-sport typically occurs at the 6-week mark following the time of the injury (REF). Physiotherapy is essential in that time to facilitate recovery and prevent future injury through an individualised shoulder strengthening programme. Exercises that focus on closed chain movements, shoulder stability, and re-integration of overhead and cross body movements are perfect for AC joint recovery. Please get in contact if you would like a full assessment and treatment for an ongoing AC joint injury.
Written By Ollie Curtis (Chartered Physiotherapist)
