Commonly, injury happens when falling onto an outstretched hand or elbow, direct blows to the shoulder, or falling onto the point of the shoulder. Diagnosis and management of grade ii acromioclavicular. Ac joint separation brisbane knee and shoulder clinic. It is very rare when ac joint arthritis is the primary cause of pain. The ac joint is held together by various ligaments. For lower grade injuries, nonsurgical treatment is usually successful. An ac joint separation or dislocation occurs when the restraints that normally secure this joint are traumatically ruptured. Shoulder dislocations and ac joint separations are often mistaken for each other. Ac joint injuries are sometimes referred to as sprains or a separated shoulder.
In young weight lifters, ac joint pain due to osteolysis of the clavicle is common cause of pain. The scapula and clavicle form the socket of the joint, and the humerus has a round head that fits within this socket. The ac joint that is formed where the acromion connects with the collarbone is known as the acromioclavicular joint. Preoperative rehabilitation is advisable prehab day 1 3 weeks. Rom, static stretch, and dynamic stretch shoulder injuries are very common in the collegeaged population. Rehabilitation guidelines for shoulder arthroscopy uw health. Heat before treatment, ice after treatment per therapists discretion dc sling at 6 weeks weeks 612. An acromioclavicular ac joint injury also known as a shoulder separation can make it difficult for you to go about your daily life, especially if it involves your dominant arm. Adults in their 20s suffer most ac joint injuries 43%. Injuries to the ac joint account for approximately 10% of acute injuries to the shoulder girdle, with separations of the ac joint accounting for 40% of shoulder girdle injuries in athletes.
Consult with an orthopedic physician if ac joint pain or chronic symptomatic instability persist discuss the benefits of completing a cfa program and introduce to cfa staff therapeutic exercise progress prior exercises to include activity at shoulder height and above add pushups with a plus at an angle table push up. Osteolysis or ac joint arthritis is the most common cause of pain on top of the shoulder. Isolated distal clavicle excision is a wellrecognized. The ac joint is not as mobile as the large main shoulder joint and only moves when the shoulder is overhead or across the chest adducted.
The ac joint is formed by the junction of the lateral clavicle and the acromion process of the scapula and is a gliding, or plane style synovial joint. Ac joint rehab protocol types i to iii phase one decrease pain. Movement system impairment syndromes of the shoulder shirley sahrmann, pt, phd, fapta professor emeritus program in physical therapy program in physical therapy mosby 2001 elsevier 2010 program in physical therapy the human movement system the body system for which physical therapists are responsible. There may be some swelling at the site ofthe joint. Acromioclavicular joint ac separations are one of the most common injuries seen in orthopedic and sports medicine practices, accounting for 9% of all injuries to the shoulder girdle. Rehabilitation guidelines for shoulder debridement. Part 4 mechanism of injury, assessment of the ac joint and diagnosis part 5 taping for the ac joint part 6 kinesio taping for the ac joint part 7 early rehab guidelines part 8 early rehab exercises rotator cuff part 9 early rehab exercises standing, seated and side lying part 10 early rehab exercises prone and supine. A shoulder separation is a fairly common injury, especially in certain sports. Conservative management of a type iii acromioclavicular. The outer end of the clavicle is held in alignment with the acromion by the acromioclavicular ligaments and the coracoclavicular cc ligaments. Diagnosis and management of grade ii acromioclavicular joint separation anna kiner 236 the circle, queen elisabeth street, london se1 2jn, uk. Do not go beyond the limit where the pain begins modalities isometric flexionextension. Weightlifters shoulder pain from an unstable ac joint feat.
Most shoulder separations are actually injuries to the acromioclavicular ac joint. Compression of the joint, such as bringing the arm across the chest may result in increased pain. Frisbie memorial hospital gr iii acromioclavicular separation. A large number of muscles and ligaments are important to the shoulder. The first phase of rehabilitation begins with flexibility. Mechanical trauma of the acromioclavicular ac joint can result in the rupture of the ligament com plex extending between the acromion, the clavicle and the. One part of the shoulder blade, called the glenoid fossa forms a flat, shallow surface. The most important are the rotator cuff muscles and the acromioclavicular ligaments along with the glenohumeral joint capsule. The rotator cuff is a group of muscles and tendons, which hold the glenohumeral joint together and help lift the arm overhead, such as throwing a ball or swimming. The acromioclavicular ac joint is the articulation between the scapula and the clavicle. As such, i figured id devote a newsletter to talking about why these injuries are such a pain in the butt, what to do to train around them, and how to prevent them in the first place or. These two bones are held together by tough, sinewy tissuesligaments that tie the bones together. Diagnosis and management of grade ii acromioclavicular joint. Ac joint separation brisbane knee and shoulder clinic dr.
Ac joint arthropathy shoulder anatomy the ac joint is located at the tip of the shoulder where the shoulder blade scapula and collarbone clavicle come together at a point called the acromion on the upper surface of the shoulder blade. The acromioclavicular ac joint is formed by the cap of the shoulder acromion and the collar bone clavicle. Chronic pain after injury, arthritic and atraumatic conditions of the acromioclavicular joint, as well as a general approach to the patient with shoulder pain and discussions of other specific. Gradually progress sport activities to unrestrictive participation continue stretching and strengthening program note well.
The ac joint is located at the tip of the shoulder where the acromion portion of the shoulder blade scapula and collarbone clavicle join together. The signs and symptoms are local tenderness over the ac joint. Sling for 3 weeks athletes can wean off sooner under guidance of club therapist teach axillary hygiene. The ac joint is located at the tip of the shoulder where the shoulder blade. Diagnostic classification is discussed together with treatment options. Ac joint sprain imaging 34 views of the shoulder ap int. Abstract an acromioclavicular ac joint separation or sprain is a traumatic. Ac joint separations treatment chiropractic woodbridge.
If the ac joint had been injured some time in the past, there may be a snap or click as the shoulder is moved, and the area of the ac joint may become more prominent. Active assisted rom to include elevation and depression of the arm in the plane of the scapula. Reconstruction of the ac joint stabilizes this important joint by utilizing multiple new restraints established. Begin sports related rehab at 3 months, including advanced conditioning. The glenoid labrum is a ring of cartilage that turns the. Getting geeky with ac joint injuries lately, ive gotten quite a few inperson evaluations and emails relating to acromioclavicular ac joint issues. Movement system impairment syndromes of the shoulder.
Consult with an orthopedic physician if ac joint pain or chronic symptomatic instability persist discuss the benefits of completing a cfa program and introduce to cfa staff therapeutic exercise progress prior exercises to include activity at shoulder height and above add pushups with a. An old school friend contacted me after a bike accident and an a. Pdf acromioclavicular joint and clavicle injuries researchgate. Rehabilitation of acromioclavicular joint separations. If the ac joint had been injured some time in the past, there may be a snap or click as the shoulder is moved, and the. Rehab of shoulder ac joint inflammation from the trainers perspective dropped down in weight, reps and frequency, icing it daily and eating ibuprofen at a therapeutic dose. The ac joint might prove to be a contributor to your painful shoulder as well. The acromioclavicular joint, or ac joint, is one of four joints that compride the shoulder complex. Another part of the scapula, called the acromium, articulates with the clavicle collerbone to make the acromioclavicular ac joint. Acromioclavicular ac joint injuries are the most frequent acute shoulder girdle injuries in athletes, and require a structured rehabilitation program to get your athletes back on the field into contact situations. The most valuable exercises in ac joint treatment are shoulder forward.
The diagnosis and treatment of acute dislocation of the. Applied to the patient through a large applicator, shortwave diathermy may be used to assist in the treatment of soft tissue injuries, slow healing wounds and arthritis. The rotator cuff is a group of muscles and tendons, which hold. Pdf acromioclavicular joint separations grades iiii. The goal of treatment for ac joint arthrosis is to eliminate pain and restore. This reduces the pain and inflammation somewhat, but its slowly getting worse. The acromion attaches to the collarbone or clavicle. Residual pain and crepitus are common with grade ii separations. Ac joint injury rehabilitation acj injuries are common due to falls on the point of the shoulder such as in falling of a bicycle and often result in a step deformity of the acj due to rupturing of the ligaments that support this structure. This shoulder conditioning program should be continued for 4 to 6 weeks, unless otherwise. The ac joint is the connection between the scapula shoulder blade and the clavicle collarbone.
The ac joint is a resilient joint that can resist significant amounts of force before disruption. This is coupled with the humerus shaped like a golf ball to make up the joint. Ac joint separation what is an ac joint separation. Pdf acromioclavicular joint acj separation injuries are common injuries among. Variances will be communicated by the surgeon directly to rehabilitation services. A mumford arthroscopic procedure resects the distal clavicle in cases of posttraumatic degenerative disease of the ac joint and shoulder impingement syndrome. Fall onto shoulder direct blow to shoulder symptoms. Acromioclavicular ac joint injuries are a common injury seen in. Often, there is a bump in the area, which can be large in people normally. Reconstruction of the ac joint stabilizes this important joint by utilizing multiple new restraints established surgically. Observation of a step deformity is an obvious sign of joint instability in grade iiiv injuries. Criteria to advance to phase 2 o 75% of from compared to opposite shoulder. The ac joint is located at the tip of the shoulder where the shoulder blade scapula and collarbone clavicle come together at a point on the upper prut ofthe shoulder blade called the acromion.
In grade iii injuries tenderness over the joint and pain reaching across to the opposite shoulder are common indicators of an ac injury. Acromioclavicular joint sprain disruption of ac ligaments, may include coracoclavicular cc ligament caused by. The joint joins your collarbone to your shoulder blade. He lives in poland so i did him a video outling some specifics around doing rehab exercises to.
Like most of the other joints in the body, it has a cartilage disk. Apr 06, 2020 an acromioclavicular ac joint injury also known as a shoulder separation can make it difficult for you to go about your daily life, especially if it involves your dominant arm. Time, rest and gradual rehabilitation typically result in a shoulder free of pain. Rehab of shoulder ac joint inflammation from the trainers. Jul 20, 2017 the ac joint might prove to be a contributor to your painful shoulder as well. Maximize functional outcomes after stroke with acps neuro. This joint or connection is known as the acromioclavicular joint ac joint. Supraspinatus supporting the shoulder joint infraspinatus supporting the shoulder joint subscapularis front of shoulder biceps front of upper arm triceps back of upper arm length of program. Use at all times except showering bathing modalities. Like most of the other joints in the body, it has a cartilage disk inside and the bone ends are covered with cartilage. Heres what you need to know about ac joint rehab, and some exercises you can do to help your shoulder heal. The ac joint has 4 ligaments, which provide stability to the joint, when any of these ligaments tear an ac sprain is the resulting injury.
Pain with cross body reachingoverhead reaching tender over ac joint instability with potential deformity. Management of type 3 acromioclavicular joint dislocations. Grade i is slight displacement of the joint, and a badly stretched or partially torn ac ligament. Ac joint symptoms are another common shoulder problem, resulting from both direct injury to the ac joint and rotator cuff impingement. Game ready ice and compression therapy fitting and instructions explained. Rehabilitation guidelines for biceps tenodesis the shoulder has two primary joints. To improve tolerance for rehab subacromial decompression only if conservative tx fails. Acromioclavicular joint separations grades iiii article pdf available in sports medicine 428 august 2012 with 3,634 reads how we measure reads. The glenohumeral joint is the connection of the arm with. Prior to ac joint stabilisation surgery for ac joint seperation injury, you are advised to visit your physiotherapist to make sure you are ready for your postop rehab. The shoulder joint is formed at the junction of three bones.