AC Joint Injury: Recovery Process, Rehabilitation, and What to Expect

What is the recovery process for AC joint?

Recovery from an acromioclavicular (AC) joint injury, typically a separation, is a multi-stage process that prioritizes pain management, restoration of range of motion, progressive strengthening, and a gradual return to activity, with the timeline and specific interventions largely dependent on the severity of the injury.

Understanding the AC Joint and Injury

The acromioclavicular (AC) joint is a small but critical articulation located at the top of the shoulder, formed by the junction of the acromion (part of the shoulder blade) and the clavicle (collarbone). It plays a vital role in shoulder movement, particularly during overhead activities, allowing for subtle adjustments and stability. An AC joint injury, commonly referred to as a shoulder separation, occurs when the ligaments supporting this joint (the acromioclavicular and coracoclavicular ligaments) are stretched or torn. This typically results from a direct blow to the top of the shoulder, such as a fall onto the shoulder or an outstretched arm.

Grading AC Joint Separations

The severity of an AC joint injury is classified into grades, which directly influence the recovery protocol and prognosis:

• Grade I: A mild sprain of the AC ligaments, with no displacement of the bones. The joint remains stable.
• Grade II: A more significant sprain or partial tear of the AC ligaments, with minimal displacement of the clavicle. The coracoclavicular ligaments are usually intact.
• Grade III: A complete tear of both the AC and coracoclavicular ligaments, resulting in noticeable upward displacement of the clavicle. This is a common threshold for considering surgical intervention, though many Grade III injuries are successfully managed non-surgically.
• Grades IV-VI: Less common and more severe injuries involving complete ligamentous tears and significant displacement of the clavicle, often requiring surgical intervention due to severe instability.

Immediate Post-Injury Management (Acute Phase)

Regardless of the grade, the initial phase of AC joint recovery focuses on pain control, reducing inflammation, and protecting the injured joint. This typically lasts for the first 1-2 weeks.

• Rest and Immobilization: The arm will likely be placed in a sling to immobilize the shoulder and prevent further stress on the AC joint. The duration of sling use varies but is generally shorter for lower-grade injuries (a few days to 2-3 weeks).
• Ice Application: Applying ice packs to the injured area for 15-20 minutes every 2-3 hours helps to reduce pain and swelling.
• Pain Management: Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help manage pain and inflammation. In some cases, stronger prescription pain medication may be necessary initially.
• Activity Modification: Avoid any activities that aggravate pain or stress the AC joint, especially overhead movements or lifting heavy objects.

Rehabilitation Phases: A Structured Approach

Following the acute phase, a structured rehabilitation program, often guided by a physical therapist, is crucial for optimal recovery.

Phase 1: Pain & Inflammation Control, Early Mobility (Weeks 1-4, Varies by Grade)

The primary goals are to continue managing pain and inflammation while gently restoring basic shoulder mobility without stressing the healing ligaments.

• Continued Protection: Gradual weaning from the sling as pain allows.
• Gentle Pendulum Exercises: Allowing the arm to hang loosely and swing gently in circles to promote blood flow and prevent stiffness without active muscle contraction.
• Passive and Assisted Range of Motion (ROM): A therapist or the uninjured arm assists the injured arm through pain-free ranges of motion, avoiding painful end-ranges.
• Isometric Exercises: Gentle muscle contractions without joint movement (e.g., pushing the elbow into the body) to maintain muscle tone and activate surrounding musculature without stressing the joint.
• Scapular Retraction Exercises: Focusing on pulling the shoulder blades back and down to improve postural support.

Phase 2: Restoring Range of Motion & Initial Strength (Weeks 3-8, Varies by Grade)

As pain subsides and initial healing occurs, the focus shifts to regaining full, pain-free range of motion and initiating light strengthening.

• Active Range of Motion (AROM): Progressing to independent movement of the shoulder in all planes, including elevation and rotation, within pain limits.
• Light Resistance Exercises: Introduction of light weights or resistance bands for exercises targeting the rotator cuff (e.g., internal/external rotations) and deltoids, ensuring proper form.
• Scapular Stability Exercises: More advanced exercises to strengthen the muscles that control the shoulder blade (e.g., rows, prone Ys and Ts) to provide a stable base for the shoulder joint.
• Core Stability: Incorporating core strengthening exercises to improve overall kinetic chain stability.

Phase 3: Progressive Strengthening & Stability (Weeks 6-16, Varies by Grade)

This phase involves progressively increasing the intensity and complexity of exercises to build strength, endurance, and dynamic stability, preparing the shoulder for more demanding activities.

• Increased Resistance: Gradually increase the weight and resistance for all shoulder and upper body exercises.
• Compound Movements: Introduction of exercises that involve multiple joints and muscle groups, such as push-ups, overhead presses (initially limited range), and pull-downs.
• Proprioceptive Training: Exercises that challenge balance and joint awareness (e.g., unstable surface exercises, medicine ball throws) to improve neuromuscular control.
• Sport-Specific Drills (if applicable): Beginning to incorporate movements relevant to the individual's sport or occupational demands, but at a low intensity.

Phase 4: Return to Activity & Sport-Specific Training (Months 3-6+, Varies by Grade)

The final phase focuses on safely returning to full activity, including sports or physically demanding occupations, ensuring the shoulder can withstand the required stresses.

• Gradual Return to Activity: Progressive reintroduction to sport-specific drills, lifting, throwing, or overhead activities. This should be a slow, controlled process, increasing intensity and duration incrementally.
• High-Intensity Strengthening: Continuing to build strength and power with heavier weights and more dynamic movements.
• Plyometric Exercises: For athletes, incorporating exercises that involve explosive movements (e.g., medicine ball throws, clap push-ups) to improve power.
• Maintenance Program: Establishing a long-term exercise routine to maintain strength, flexibility, and stability, reducing the risk of re-injury.

Surgical vs. Non-Surgical Recovery

For Grade I and II AC joint separations, non-surgical management is almost always the preferred approach, with excellent outcomes. For Grade III injuries, the decision between surgical and non-surgical management is often individualized, considering factors like the patient's age, activity level, and cosmetic concerns. Grades IV-VI typically necessitate surgical reconstruction.

• Non-Surgical Recovery: Generally involves the phased rehabilitation described above. Full recovery can range from 6 weeks for Grade I to 3-6 months or more for Grade III.
• Surgical Recovery: Involves an initial period of more stringent immobilization (often 4-6 weeks in a sling) to protect the surgical repair. The rehabilitation phases are similar to non-surgical recovery but are delayed in their start and often progress more cautiously. Full return to sport or heavy activity can take 6-12 months or longer.

Important Considerations During Recovery

• Pain Management: Listen to your body. Pain is a signal. While some discomfort is normal during rehab, sharp or increasing pain indicates you may be overdoing it.
• Patience and Adherence: Recovery is not linear. There will be good days and bad days. Consistency with your rehabilitation program is paramount, even when progress feels slow. Rushing the process can lead to re-injury or chronic issues.
• Proper Biomechanics: Focus on maintaining good posture and movement patterns throughout daily activities and exercises. Poor shoulder mechanics can impede recovery and predispose to future problems.
• Nutrition and Lifestyle: A balanced diet rich in protein, vitamins, and minerals supports tissue healing. Adequate sleep and stress management also contribute to overall recovery.
• Long-Term Outlook: While most people recover well, some may experience residual stiffness, mild aching, or the development of post-traumatic arthritis in the AC joint later in life, particularly with higher-grade injuries.

When to Seek Professional Guidance

It is crucial to work closely with healthcare professionals throughout your AC joint recovery. Consult an orthopedic surgeon or sports medicine physician for diagnosis and initial management. A physical therapist is an invaluable partner in guiding your rehabilitation, ensuring proper technique, progression, and addressing any setbacks. Seek immediate medical attention if you experience:

• Sudden, severe increase in pain
• New or worsening numbness, tingling, or weakness in the arm or hand
• Signs of infection (fever, redness, warmth, pus at a surgical site)
• Inability to move the arm, despite previous progress