ACROMIOCLAVICULAR JOINT INJURIES

AND PHYSICAL THERAPY MANAGEMENT

The acromioclavicular, or AC, joint is part of the

shoulder girdle (the collar bone and shoulder
blade that support the shoulder joint). An AC
joint injury describes an injury to the top of the
shoulder. It occurs where the front of the
shoulder blade (acromion) attaches to the
collarbone (clavicle). Most often, trauma, such
as a fall directly on the outside of the shoulder,
causes an AC joint injury. Overuse (repeated
lifting of heavy weights or objects overhead
with poor mechanics) also can result in an AC
joint injury.
AC joint injuries are most common in people
younger than age 35. Males sustain five times
more traumatic AC joint injuries than females.
Younger athletes who take part in activities like
football, biking, skiing, and hockey have the
highest risk for this injury.
Physical therapists can identify and effectively
treat AC joint injuries, often avoiding the need
for surgery.
There are four ligaments that hold the two
bones of the AC joint together. When an AC
joint injury occurs, these ligaments are
stressed. This stress results in some degree of
joint separation. There are two types of injuries
of the AC joint: traumatic and overuse injuries.
Traumatic AC joint injury
This type of injury occurs when the joint is
disrupted. The ligaments that hold the two
bones of the joint together get stretched too
far. This is called a shoulder separation. It is
different from a shoulder dislocation, which
involves the ball-and-socket joint.
Traumatic AC joint injuries are most common in
people who fall and land on the outside of the
shoulder or hand. Examples include a:
 Football player who is tackled.
 Cyclist who crashes.
 Worker who falls off a ladder
Traumatic AC joint injuries can range from a
mild to severe grade. Grading is based on the
amount of joint separation involved. Mild cases
can be treated by a physical therapist. More
severe cases may require surgery followed by
physical therapy.
Overuse AC joint injury
This type of injury occurs over time due to
repeated and too much stress on the joint.
Cartilage at the end of the acromion and
clavicle bones protects the joint from daily
wear and tear.
Over time, the demand placed on this cartilage
may be more than it can endure. The result is
an overuse injury that can lead to major
wearing of the cartilage and arthritis. Overuse
AC joint injury is most common in people who
do repeated tasks. Examples include:
 Heavy weightlifting (bench and military
presses).
Jobs that require physical work with the arms
stretched over the  AC joint injury, you may
experience:
 General shoulder pain and swelling.
 Swelling and tenderness over the AC joint.
 Loss of shoulder strength.
 A visible bump above the shoulder.
 Pain when lying on the involved side.
  Loss of shoulder motion.
 A “popping” sound or feeling that your
shoulder “catches” with movement.
 Discomfort with daily activities that stress
the AC joint. Examples include lifting objects
overhead, reaching across your body, or
carrying heavy objects at your side.
 head.
Diagnosis
Physical therapists can diagnose an AC joint
injury through a shoulder exam. Your physical
therapist will conduct a full evaluation to find
out the degree of your injury and identify all
the factors that may contribute to it.
They will begin by interviewing you to learn
about your health history. They may be helped
by forms you fill out before your first session.
The interview will become more specific to the
condition of your shoulder. Your physical
therapist may ask you questions such as:
 How did your injury occur?
 How have you taken care of the condition,
such as seeing other health care providers?
Have you had imaging (X-ray, MRI) or other
tests and received their results?
 What are your current symptoms? How
have they changed your typical day and
activities?
 Do you have pain, and if so, what is the
location and intensity of your pain? Does
the pain vary during the day?
 Do you have trouble doing any activities?
What activities are you unable to do?
This information allows the physical therapist
to better understand what you are going
through. It also helps determine the course of
your physical exam.
The physical exam will vary depending on your
interview. Most often it will begin with
observing the region of your symptoms and any
movements or positions that cause pain. Your
physical therapist also may examine other
areas of your body that may have changed due
to problems with your shoulder function. They
may:
 Watch you move your arm and shoulder
overhead, and while doing other reaching
tasks.
 Assess the mobility and strength of your
shoulder.
  Check other regions of the body as needed.
This will help to determine if other areas
also require treatment to improve your
condition.
 Gently, but skillfully, feel around your
shoulder and the AC joint to find exactly
where it is most painful.

Physical therapy management

Your physical therapist will design a treatment
plan to help you safely return to your desired
activities. Your treatment plan may include:
 Patient education. Your physical therapist will
educate you about your AC joint and shoulder
injury. They will work with you to identify any
external factors causing your pain, including the
amount and type of exercises and activities you
do. Your physical therapist will recommend
improvements to your activities.
 Pain management. Your physical therapist
will address your pain. This may include
applying ice to the affected area and other
methods. They also may recommend changing
some activities that cause pain. Physical
therapists are experts in prescribing pain-
management methods. These can reduce or
eliminate the need for medicines, including
opioids.
 Range-of-motion exercise. The mobility of
the AC joint and shoulder may be limited,
causing increased stress on the shoulder. Your
physical therapist may teach you self-stretching
methods. These can decrease tension and help
restore normal motion of your injured joints.
 Manual therapy. Your physical therapist may
apply hands-on treatments to gently move your
muscles and joints. These techniques help to
improve movement. Your physical therapist also
may use manual therapy to guide your shoulder
area into a less stressful movement pattern.
 Muscle strength. Muscle weaknesses or
imbalances can contribute to problems of
the AC joint and shoulder. They also can
cause continued symptoms. Based on the
how serious your injury is, your physical
therapist will design a safe resistance
program to aid your recovery. Exercises
may include using resistance machines in
the clinic and doing exercises to strengthen
your core (midsection). You may begin
doing exercises while lying on a table or at
home on the bed or floor. You then may
advance to exercises done in a standing
position. Your physical therapist will choose
what exercises are right for you based on
your diagnosis, age, and condition. They will
determine when it is safe for you to
exercise on your own at home or in a gym.
  Functional training. Once your pain,
strength, and motion improve, functional
training can help you safely resume more
demanding activities. To minimize the stress
to the AC joint and shoulder it is important
to teach your body safe, controlled
movements. Your physical therapist will
create a series of activities to help you learn
how to use and move your body correctly
and safely. These may include retraining
your movements and positioning when
throwing, swinging a racket, lifting objects
overhead, or doing other daily activities.
Prevention
Accidents happen and it can be difficult to
prevent many traumatic AC joint injuries.
However, much can be done to prevent the
string of events that lead to overuse injuries.
Physical therapists can help reduce overuse
injuries by:
 Teaching you how to properly lift objects
overhead at work.
 Demonstrating good form for overhead
resistance training or sports activities.
 Helping you maintain general shoulder
strength and motion to safely perform
tasks.