AC Joint Care: Understanding Injuries, Immediate Steps, and Long-Term Rehabilitation

How Do You Take Care of an AC Joint?

Taking care of an acromioclavicular (AC) joint, particularly after an injury, involves a multi-faceted approach beginning with immediate acute management to reduce pain and inflammation, followed by a structured rehabilitation program focused on restoring mobility, strength, and stability, and finally, long-term strategies for prevention.

Understanding the AC Joint

The acromioclavicular (AC) joint is a small but crucial joint located at the top of the shoulder, where the lateral end of the clavicle (collarbone) meets the acromion, a bony projection of the scapula (shoulder blade). This joint, stabilized by the AC ligaments and the stronger coracoclavicular (CC) ligaments, facilitates a wide range of shoulder movements, especially overhead activities. While resilient, it is susceptible to injury, most commonly sprains (also known as AC joint separations) resulting from direct impact to the shoulder or falls onto an outstretched arm. These injuries are graded based on the severity of ligamentous damage and displacement of the joint.

Recognizing an AC Joint Injury

An AC joint injury, typically a sprain, presents with distinct symptoms:

• Localized Pain: Sharp pain directly over the top of the shoulder at the AC joint, often worsening with arm movement, especially across the body or overhead.
• Tenderness: The joint area will be tender to the touch.
• Swelling and Bruising: Inflammation and discoloration may be present around the joint.
• Deformity: In more severe separations (Grade II or higher), a visible bump or step-off deformity may appear at the top of the shoulder, where the clavicle is displaced upwards.
• Limited Range of Motion: Difficulty and pain when moving the arm, particularly lifting it or reaching across the body.
• Clicking or Popping: May be felt or heard with movement in some cases, especially if arthritis develops later.

Diagnosis typically involves a physical examination, palpation of the joint, and specific stress tests. X-rays are often used to confirm the diagnosis and assess the grade of separation.

Immediate Care for an AC Joint Sprain (Acute Phase)

For acute AC joint injuries, especially Grade I and II sprains, immediate care focuses on reducing pain and inflammation and protecting the joint from further damage. This typically follows the RICE protocol:

• Rest: Immediately cease activities that aggravate the shoulder. Avoid lifting, pushing, or pulling, and minimize arm movements.
• Ice: Apply ice packs to the affected area for 15-20 minutes every 2-3 hours to reduce swelling and pain. Ensure a barrier (e.g., cloth) between the ice and skin.
• Compression: While direct compression on the AC joint can be difficult due to its location, a shoulder sling provides gentle compression and support by reducing gravitational pull on the arm and clavicle.
• Elevation: Keep the arm elevated as much as comfortable, especially when resting, to help manage swelling.
• Pain Management: Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help manage pain and inflammation. Always follow dosage instructions and consult a healthcare professional if unsure.
• Immobilization: A sling is often recommended for Grade I and II injuries for a period of 1-3 weeks to immobilize the shoulder, protect the joint, and allow the ligaments to begin healing. For higher-grade injuries, more rigid immobilization or surgical intervention may be required.

Rehabilitation and Long-Term Care (Sub-Acute & Chronic Phases)

Once acute pain and swelling subside, a structured rehabilitation program is crucial for restoring full function and preventing chronic issues. This phase is best guided by a physical therapist or kinesiologist.

• Gradual Mobilization and Range of Motion (ROM):
  • Begin with passive and active-assisted range of motion exercises to gently restore movement without stressing the healing ligaments. This might include pendulum swings or using the non-injured arm to assist movements.
  • Progress to active range of motion exercises as pain allows, focusing on full, pain-free movement in all planes.
• Strengthening Exercises:
  • Scapular Stability: Crucial for supporting the shoulder girdle. Exercises like scapular squeezes, rows, and prone Y, T, and W raises help strengthen the rhomboids, trapezius, and serratus anterior.
  • Rotator Cuff Strengthening: Exercises targeting the supraspinatus, infraspinatus, teres minor, and subscapularis (e.g., external and internal rotations with light resistance bands, empty can raises) are vital for shoulder stability and dynamic control.
  • Deltoid and Upper Trapezius: Gradually introduce exercises for these muscles, being mindful of not overstressing the AC joint. Side raises and front raises with light weights can be incorporated.
• Proprioception and Neuromuscular Control:
  • Exercises that challenge balance and coordination of the shoulder complex help improve the joint's ability to sense its position and react appropriately. This might include stability ball exercises or controlled movements in various planes.
• Activity Modification and Return to Sport/Activity:
  • Gradually reintroduce daily activities, avoiding movements that cause pain.
  • For athletes, a progressive return-to-sport protocol is essential, ensuring the shoulder has regained full strength, power, and pain-free range of motion before resuming high-impact or overhead activities. This often involves sport-specific drills.
  • Listen to your body; pain is a signal to modify or reduce activity.

Preventing Future AC Joint Issues

Proactive measures can significantly reduce the risk of re-injury or developing chronic AC joint problems:

• Maintain Overall Shoulder Health: Regularly incorporate exercises that strengthen the rotator cuff, scapular stabilizers, and deltoids into your fitness routine.
• Proper Lifting Mechanics: Always use proper form when lifting weights, especially overhead. Avoid shrugging the shoulders excessively during exercises like overhead presses, which can impinge the AC joint.
• Fall Prevention: Be mindful of surroundings, especially on uneven surfaces. For older adults, balance training can be crucial.
• Protective Gear in Sports: In contact sports or activities with a high risk of falls (e.g., cycling, football, hockey), wear appropriate shoulder pads or protective gear.
• Address Muscle Imbalances: Work with a fitness professional to identify and correct any muscle imbalances around the shoulder girdle that could predispose the AC joint to undue stress.
• Listen to Your Body: Do not push through pain. If an activity causes discomfort in the AC joint, modify it or take a break.

When to Seek Professional Medical Attention

While many AC joint injuries can be managed conservatively, it is crucial to seek professional medical attention if:

• You suspect a moderate to severe AC joint separation (Grade II or higher), indicated by a significant visible deformity or severe pain and instability.
• Pain is severe, unmanageable with over-the-counter medication, or worsens despite rest and home care.
• There is significant swelling, bruising, or numbness/tingling in the arm or hand.
• You experience a complete loss of function in the shoulder.
• Symptoms persist for several weeks without improvement, despite consistent rehabilitation efforts.

A medical professional can accurately diagnose the extent of the injury, recommend appropriate imaging, and guide you through the most effective treatment plan, which may include physical therapy, injections, or, in rare severe cases, surgical intervention.