AC Joint Injuries: Non-Surgical Treatment, Rehabilitation, and Recovery

How do you heal an AC joint without surgery?

Healing an AC joint injury without surgery typically involves a multi-phase approach focusing on initial pain and inflammation management, progressive rehabilitation exercises to restore stability and range of motion, and gradual return to activity, guided by the injury's grade and individual progression.

Understanding the AC Joint and Injury Grades

The acromioclavicular (AC) joint is located at the top of the shoulder, where the collarbone (clavicle) meets the highest part of the shoulder blade (acromion). It is stabilized by several ligaments, most notably the acromioclavicular (AC) ligaments and the coracoclavicular (CC) ligaments. Injuries to this joint, often resulting from a direct fall onto the shoulder or a direct blow, are classified into grades based on the severity of ligamentous damage and joint displacement:

• Grade I: A sprain of the AC ligaments with no displacement of the joint. The joint capsule remains intact.
• Grade II: A complete tear of the AC ligaments, but the CC ligaments remain intact or are only partially sprained. There is some subtle upward displacement of the clavicle.
• Grade III: Complete tears of both the AC and CC ligaments, resulting in noticeable upward displacement of the clavicle.
• Grades IV-VI: More severe injuries involving greater displacement and often posterior or inferior displacement of the clavicle, typically requiring surgical intervention.

Non-surgical healing is primarily applicable to Grade I, II, and in many cases, Grade III injuries, depending on patient factors and functional demands.

Initial Management: Acute Phase (0-2 Weeks)

The immediate goal following an AC joint injury is to reduce pain and inflammation and protect the joint from further damage.

• Rest: Avoid activities that exacerbate pain or stress the AC joint. This includes overhead movements, heavy lifting, and direct pressure on the shoulder.
• Immobilization: A sling may be used for a short period (typically 1-2 weeks for Grade II/III, or less for Grade I) to provide support and limit movement, allowing the torn ligaments to begin the healing process. Prolonged immobilization should be avoided to prevent stiffness.
• Ice: Apply ice packs to the affected area for 15-20 minutes, several times a day, especially in the first 48-72 hours, to reduce swelling and pain.
• Pain Management: Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help manage pain and inflammation. Always consult a healthcare professional before starting any medication.
• Activity Modification: Be mindful of daily activities. Avoid carrying heavy bags on the affected side or sleeping directly on the injured shoulder.

Rehabilitation Phase: Restoring Function (2-12+ Weeks)

Once acute pain subsides and initial healing has occurred, the focus shifts to restoring range of motion, strength, stability, and functional capacity. This phase is progressive and should be guided by a physical therapist or kinesiologist.

• Early Pain-Free Range of Motion (ROM):
  • Pendulum Swings: Gently lean forward, letting the arm hang freely, and make small, controlled circular motions.
  • Passive/Active-Assisted ROM: Using the uninjured arm or a pulley system to gently move the injured arm through its pain-free range, avoiding end-range stress on the AC joint.
• Scapular Stability and Control: Strengthening the muscles that stabilize the shoulder blade is crucial, as scapular dyskinesis can contribute to AC joint stress.
  • Serratus Anterior Activation: Wall slides, push-up plus.
  • Rhomboids and Middle/Lower Trapezius: Prone Y-T-W-L exercises (performed without pain).
• Rotator Cuff Strengthening: The rotator cuff muscles (supraspinatus, infraspinatus, teres minor, subscapularis) are vital for shoulder stability.
  • Isometric Exercises: Gentle contractions without movement, if pain allows.
  • External and Internal Rotations: With light resistance bands or very light weights, keeping the elbow tucked.
  • Scaption: Raising the arm in the scapular plane (about 30 degrees forward of the body) to roughly 90 degrees, with light resistance.
• Deltoid Strengthening (Gradual Progression): As the AC joint heals, the deltoid can be carefully strengthened.
  • Front Raises and Lateral Raises: Start with very light weights or bodyweight, ensuring no pain or clicking in the AC joint.
• Proprioception and Neuromuscular Control: Exercises that challenge balance and coordination help improve joint awareness and stability.
  • Wall Push-Ups: Progressing to unstable surfaces if appropriate.
  • Rhythmic Stabilization: Partner applies gentle, unpredictable resistance to the arm, requiring the shoulder muscles to react and stabilize.
• Gradual Return to Activity: This phase involves progressively increasing the load and complexity of movements, mimicking sport- or occupation-specific demands.
  • Functional Movements: Incorporate movements relevant to daily life or sport, starting with bodyweight and gradually adding resistance.
  • Plyometrics (if applicable): For athletes, controlled plyometric exercises may be introduced under supervision.

Key Principles of Non-Surgical Rehabilitation

• Pain as a Guide: Never push through pain. Pain indicates that the tissue is being overloaded or irritated.
• Gradual Progression: Increase intensity, duration, and resistance incrementally. Rushing the process can lead to re-injury or chronic issues.
• Consistency: Adherence to the prescribed exercise program is paramount for optimal healing and recovery.
• Holistic Approach: Address any underlying postural imbalances or weaknesses in the kinetic chain (e.g., core, thoracic spine mobility) that might contribute to shoulder dysfunction.
• Professional Guidance: Working with a physical therapist or kinesiologist is highly recommended. They can provide an accurate diagnosis, tailor an exercise program, monitor progress, and ensure safe progression.

When to Consider Medical Consultation (Red Flags)

While many AC joint injuries heal well without surgery, it's crucial to consult a medical professional if you experience:

• Persistent or Worsening Pain: If pain does not improve with rest and rehabilitation, or if it intensifies.
• Significant Deformity: If the clavicle appears significantly displaced, or the "bump" on the shoulder is very prominent.
• Loss of Sensation or Weakness: Numbness, tingling, or significant weakness in the arm or hand.
• Inability to Perform Daily Activities: If the injury severely limits your ability to perform basic tasks.
• Signs of Infection: Redness, warmth, pus, or fever around the injury site.

Preventing Re-Injury

Once healed, continue to prioritize shoulder health.

• Maintain Strength and Stability: Incorporate ongoing scapular and rotator cuff strengthening exercises into your fitness routine.
• Proper Technique: Use correct form during exercises and sports activities to minimize stress on the AC joint.
• Warm-Up and Cool-Down: Always prepare your muscles for activity and aid recovery afterward.
• Avoid Overuse: Listen to your body and avoid excessive or repetitive overhead movements that could irritate the joint.

Healing an AC joint without surgery is a process that demands patience, consistent effort, and adherence to a structured rehabilitation program. With appropriate management and progressive exercise, most individuals can achieve excellent long-term functional outcomes.