AC Joint Injury
What is it?
The acromioclavicular joint (AC) is located at the top of the shoulder and is where the shoulder blade is connected to the collarbone. The AC joint is essential to the function and stability of the shoulder joint. Sitting above the shoulder joint, the AC joint is particularly prone to injury in a sporting environment.
The AC joint is held together by two main ligaments, the acromioclavicular (AC) ligament and the coracoclavicular (CC) ligament. When an injury to the AC joint occurs, these ligaments are typically compromised and damaged.
The severity of an AC joint injury can be graded with the Rockwood classification:
- Type 1: mild sprain of AC ligament.
- Type 2: ruptured AC ligament and sprained CC ligament.
- Type 3: superior dislocation of the AC joint with ruptured AC ligament, CC ligament and joint capsule.
- Type 4: posterior dislocation of the AC joint with ruptured AC ligament, CC ligament, and joint capsule.
- Type 5: gross superior dislocation of the AC joint with ruptured AC ligament, CC ligament, and joint capsule.
- Type 6: inferior dislocation of the AC joint with ruptured AC ligament, CC ligament, and joint capsule.
Within a sporting environment, it is most common to experience a type 1 or type 2 Rockwood AC joint injury. Both classifications are traditionally managed conservatively and non-operatively.
Type 3 Rockwood AC joint injuries are generally managed nonoperatively; however, in some cases, will require surgical intervention.
Type 4, 5 and 6 are more uncommon, and all require orthopaedic review and most commonly, surgical intervention.
It is also important to consider that it is possible to experience a chronic AC joint injury. A chronic AC joint injury may be secondary to degenerative changes at the joint due to certain movements. This may result in generalised shoulder pain and/or a loss of shoulder strength.
Tailored physiotherapy and strengthening and conditioning is essential to rehabilitation of any classification of AC joint injury.
Symptoms commonly associated with AC joint injuries
SYMPTOMS MAY INCLUDE:
- Swelling and tenderness over the AC joint
- Generalised shoulder pain
- A visible bump above the shoulder
- Pain lying on the affected side
- Loss of shoulder range of motion
- Loss of shoulder strength
- A popping or clicking sound with movement of shoulder
Contributing Factors associated with AC joint injuries
MODIFIABLE:
- Shoulder strength (shoulder internal rotation, external rotation, abduction)
- Shoulder biomechanics
- Body mass
- Type of sporting activity
NON-MODIFIABLE:
- Blunt trauma or knock to the shoulder joint.
- Gender
- Genetic joint laxity
- Past injury
Considerations in the management of AC joint injury
SHORT TERM
TAPING
Taping may be utilised to provide short term pain relief during aggravating activities.
LOAD MANAGEMENT
A reduction in training loads to allow damaged tissues to recover and settle the inflammatory process.
SOFT TISSUE TECHNIQUES (MASSAGE) AND DRY NEEDLING
Applying massage and other techniques to reduce muscle soreness and stress through the AC joint can reduce pain and improve shoulder function.
NON-STERODIAL ANTI-INFLAMMATORIES
Anti-inflammatories can aid recovery and settle the inflammatory process. Always consult your GP or pharmacist before taking any medication.
It is also necessary to consider principles of PEACE & LOVE. Generally, it is recommended the consumption of anti-inflammatory medication should be avoided within the first 48-72 hours of an acute AC joint injury.
IMMOBILISATION IN A SLING
Depending on the severity of an AC joint injury, a period of immobilisation in a sling may be necessary. This is to offload the AC joint and surrounding tissues in order to allow recovery to damaged tissues and inflammation to improve.
LONG TERM
RESISTANCE TRAINING
A specific and tailored strengthening and conditioning program should be conducted to improve long term outcomes and minimise risk of re-injury.
MOBILITY EXERCISES
It is important to consider mobility exercises for long term management of AC joint to maintain optimal shoulder joint mechanics, including pectoralis major, pectoralis minor, latissimus dorsi and upper thoracic.
ONGOING TRAINING LOAD MANAGEMENT
Training volume should be monitored and tailored for individuals to mitigate risk of re-injury or ongoing symptom exacerbation due to overload.
SUMMARY
The AC joint is essential to the function and stability of the shoulder joint. Physiotherapy and strengthening and conditioning is essential to the effective management of AC joint injuries.
AC joint injuries are most commonly managed nonoperatively; however, pending the severity of an injury, may require surgical intervention.
If you have any questions or concerns, please do not hesitate to contact us on (03) 5229 3911, email us at info@theinjuryclinic.com.au or book an appointment to see one of our Physiotherapists in Geelong.
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