Acromioclavicular Joint Injury

• Fall onto an outstretched hand or elbow.
• A direct blow or fall onto the point of the shoulder.
• A road traffic accident.
• Acromioclavicular joint injuries are commonly seen in contact sports such as football, rugby, hockey, cycling, skiing/snowboarding and road traffic accidents ⁽⁴⁾.

Your musculoskeletal physiotherapist will take a detailed history to understand how the injury occurred and what your symptoms are. Following this, a comprehensive physical assessment will be completed to establish your function and test specific structures to assist with the accurate diagnosis so that the most appropriate and effective treatment can begin straight away.

In cases where the function is relatively well maintained, there are several physical tests that will help establish the grade of the injury – usually I – III. However, in some cases, an X-ray is utilised to assist with grading and to guide ongoing treatment and management.

Your musculoskeletal physiotherapist will work with you to develop a set of individualised goals to help direct your treatment and facilitate optimal recovery with a successful return to normal activity/sporting performance. We value reassessment to ensure you are making progress and to allow adjustments in your treatment to be made.

Alongside a referral within 48 hours if deemed appropriate:

• A sling/brace is advised to immobilise the shoulder; this can be used in tandem with taping to provide the joint with additional support ⁽⁷⁾. Elevating the shoulder to a comfortable height is also suggested when resting. A sling can be used until symptoms diminish and function returns.
• For grade I – III injuries, patients typically return to normal function at 2-4, 4-6 and 6-12 weeks respectively ⁽³⁾. Optimal treatment remains uncertain for type III injuries as favourable outcomes have been observed in both conservative and surgical management. For overhead athletes and those with physical jobs that require higher functional demands for the shoulders, surgical intervention is recommended for greater restoration of function and as such, treatment options should be individualised ^{(2, 5, 7)}.
• For type IV injuries and upwards, surgery is often indicated to restore normal anatomy and stability through ligament reconstruction ^{(2, 5, 9)}.
• Your physio will help explain the injury and what structures are involved so that you can understand your symptoms and help support your own recovery. As you recover, we provide ongoing guidance so that you can effectively return to your normal activities whilst minimising the likelihood of future complications.

In severe and traumatic cases, grade IV – VI, there is a high likelihood that surgical intervention will be required as the preferred treatment approach ⁽⁴⁾. Despite continuous advances in surgical procedures – with up to 160 various techniques described ⁽⁹⁾ – the gold standard for surgical intervention remains elusive, however, the evidence recommends that each surgeon’s expertise – alongside deliberating the associated benefits and risks – should dictate the procedure used ^{(5, 9)}.

Surgery will restore normal anatomy and stability to the joint. Post-surgical management is very similar to that of lower grade injuries beginning with increasing range of motion before moving on to strengthening exercises and graded exposure to higher level exercise for return to baseline function.

ShoulderDoc – Shoulder Symptoms, Treatment, Research & Education

Shoulder pain – NHS (www.nhs.uk)

Acromioclavicular Joint Separation | Orthogate

ACJ Stabilisation Post-Op Protocol – Derby Shoulder Unit