How To Rehab Ac Joint? (Perfect answer)

AC joint sprain mobility exercises

  1. Front shoulder stretch. Place one forearm on a fixed point such as a doorframe or corner of a wall and gently turn away from it to stretch the front of the shoulder.
  2. External rotation stretch.
  3. Internal Rotation.
  4. External rotation.
  5. Abduction/lateral raise.


How long does it take an AC joint to heal?

It takes about four to six weeks to get complete motion and a few more weeks to begin regaining strength. Recovery is variable depending upon many factors but most patients are back to full activity by three months.

What is the fastest way to heal an AC joint?

Treatment for AC joint sprain

  1. Rest. This allows your shoulder to heal.
  2. Sling. This protects the shoulder and holds the joint in a good position for healing.
  3. Cold packs. These help reduce swelling and relieve pain.
  4. Prescription or over-the-counter pain medicines.
  5. Arm and shoulder exercises.

Can AC joint heal itself?

Depending on how severe the injury is, it may heal adequately in two to three weeks. In severe cases, the shoulder may not heal without surgery.

What exercises can I do with AC joint injury?

AC joint recovery exercises may include:

  • Neck rotation.
  • Shoulder rolls.
  • Neck stretches.
  • Shoulder blade squeeze.
  • Laying down shoulder flexion.
  • Standing shoulder extension.
  • Goalpost stretch.

Do AC joint ligaments grow back?

Or the ligaments that support your AC joint may be repaired. A ligament from another part of your body may be used to repair it. Your end result may also depend on the severity of your injury. Most people will get back all or almost all normal arm and shoulder function, but a slight deformity may remain.

How do you know if you tore your AC joint?

Symptoms of an AC joint injury

  1. Shoulder or arm pain.
  2. A visible bump, bruise, or swelling on your shoulder.
  3. Limited shoulder mobility.
  4. Weakness in your shoulder or arm.
  5. Pain when lying on the affected side.
  6. A popping sound when you move your shoulder.

How do you heal an AC joint separation?

Treatment is typically an arm sling, bed rest, ice and heat therapy, and anti-inflammatory drugs. Most people recover full motion of the shoulder and arm within 6 to 8 weeks, often with the assistance of physiotherapy.

What does AC joint pain feel like?

With an AC joint injury, you may experience: General shoulder pain and swelling. Swelling and tenderness over the AC joint. Loss of shoulder strength.

Can a chiropractor fix AC joint?

Chiropractic has been proven to be very effective for AC joint pain. The chiropractor performs what is called an AC adjustment which involves manipulation of the shoulder. While it can be a little uncomfortable for the patient, it is one of the best ways to quickly decrease the pain.

Is an AC joint separation a dislocation?

An AC joint separation, often called a shoulder separation, is a dislocation of the clavicle from the acromion. This injury is usually caused by a blow to the shoulder, or a fall in which the individual lands directly on the shoulder or an outstretched arm.

Why is my AC joint popping?

A painful clicking acromioclavicular joint (ACJ) may be due to a single traumatic event, or chronic repetitive loading. In a single injury the ACJ ligaments are torn, along with rupture of the ACJ meniscus.

How serious is an AC joint injury?

Mild injuries are not associated with any significant morbidity, but severe injuries can lead to significant loss of strength and function of the shoulder. Acromioclavicular injuries may be associated with a fractured clavicle, impingement syndromes, and more rarely neurovascular insults.

Is AC joint Same as rotator cuff?

The shoulder joint is the connection between the bone in the arm and the shoulder blade. There actually is another joint in the shoulder too, called the AC joint, which unites the collarbone and the shoulder blade. The rotator cuff is a group of muscles and the tendons that attach these muscles to the arm bone.

How should I sleep with AC joint pain?

Give these positions a try:

  1. Sit in a reclined position. You may find sleeping in a reclined position more comfortable than lying flat on your back.
  2. Lie flat on your back with your injured arm propped up with a pillow. Using a pillow may help reduce stress and pressure on your injured side.
  3. Lie on your uninjured side.

Physical Therapy for AC Joint Separation – Information, Exercises, and More

If you’ve recently suffered an injury to your acromioclavicular (AC) joint, or suspect that you have, you’re likely suffering discomfort, swelling, and a lack of strength in your shoulder. You could be wondering if you’ll need surgery in the near future. Fortunately, most AC joint rehabilitation involves solely of physical therapy, allowing patients to skip surgery completely. The most important thing is to get your injuries assessed as soon as you notice any discomfort. Everything you need to know about acromioclavicular joint physical therapy and what you may anticipate from your rehabilitation is covered in this article, so read on!

What is AC Joint Separation?

Four ligaments connect your clavicle (collarbone) to your acromion (shoulder blade), which helps to stabilize your shoulder joint. The term “AC joint injury” or “AC joint separation” refers to the force placed on these ligaments that results in some type of separation of the joint. The severity of these injuries can range from minor to severe, depending on the extent of trauma and detachment sustained. The following are the two forms of AC joint injuries that can occur: Four ligaments connect your clavicle (collarbone) to your acromion (shoulder blade), which helps to stabilize the joint.

According on the severity of the trauma and detachment, these injuries might range from minor to severe.

What Causes AC Joint Separation?

The American Chiropractic Association estimates that around 13 million Americans suffer from shoulder discomfort each year, with 31 percent of them suffering from AC joint pain, which can be caused by trauma or overuse.

Traumatic AC Joint Injury

Those who suffer a violent fall and land on their hand or the top of their shoulder are most likely to have a traumatic AC joint injury. As an illustration:

  • When a football player gets tackled, it is referred to as tackling. When a downhill skier loses his or her balance
  • When a biker loses control of his or her bicycle
  • In the event that a painter falls from his or her ladder

Overuse AC Joint Injury

When an excessive amount of pressure is applied on the AC joint over a lengthy period of time, the cartilage that protects the bones can become overworked and damaged. Arthritis is a condition in which the cartilage has been subjected to a large amount of stress and wear. Individuals who participate in recurrent activities that require them to stretch their arms over their heads are at risk of developing this condition. As an illustration:

AC Joint Separation Symptoms

If you have an injury to your AC joint, you may experience the following symptoms:

  • Swelling and discomfort
  • Tenderness in the area of the AC joint
  • A reduction in shoulder strength and range of motion
  • When moving the shoulder, you may hear a popping sound or experience a catching sensation. In addition, there is a prominent hump on top of the shoulder. When lifting, reaching, or carrying goods, there is discomfort in the shoulder.

Injuries to the AC joint can be detected and treated by a physical therapy professional. It may be necessary for you to undergo diagnostic imaging tests to establish the degree of your injuries, such as the following: If you are experiencing difficulty, your physical therapist will perform many different tests and will ask you to show the movements and activities that are causing you distress. Examination will also be performed on other body parts such as your neck and back to establish whether they are playing a role in the injury.

AC Joint Separation Treatment

The degree of the damage determines the course of treatment for AC joint separation.

Once a diagnosis has been determined, your therapist will collaborate with you to build a treatment plan that is tailored to your specific needs.

Grade 1 AC Joint Separation: Physical Therapy Protocol

If you have an AC joint injury of grade 1, you may be obliged to do the following:

  • Take anti-inflammatory medicine and keep the injury immobilized for 5–7 days
  • Ice the injury for 48–72 hours
  • And rest.

As soon as your symptoms begin to improve, your physical therapist will put together a treatment plan that will include the following components:

  • Range of motion exercises
  • Strengthening exercises
  • Manual treatment
  • Functional training
  • And patient education are all recommended.

Exercises to increase range of motion; strengthening exercises; manual treatment; functional training; and patient education

Grade 2 AC Joint Separation: Physical Therapy Protocol

Treatment options for grade 2 AC joint separation may include the following:

  • Icing the injuries for 48 to 72 hours
  • Using anti-inflammatory medicine
  • And wearing a sling for 1 to 2 weeks are all recommended.

Once you have been approved for therapy, your physical therapist will design a rehabilitation plan for you that is based on the therapies listed above, but with a more comprehensive approach. Patients should be able to return to their usual activities within two to three weeks of the procedure.

Grade 3 AC Joint Separation: Physical Therapy Protocol

The same procedures used for grade 1 and 2 joint separation are used for grade 3 AC joint damage, which requires immediate intervention. Physical therapy is just as beneficial as surgery in the treatment of grade 3 ac joint injuries, according to the medical community’s emerging agreement. Your physical therapist will recommend modest range-of-motion and isometric exercises, which will be followed by a more organized physical rehabilitation program. Physical treatment for Grade 3 AC joint separation might continue up to 8 weeks or longer depending on the patient’s needs.

AC Joint Physical Therapy – Will PT Help?

If you have experienced a traumatic or overuse injury to your AC joint, a physical therapist can not only identify the problem, but they will also most likely be able to cure the separation without the need for surgery. You may be able to return to your typical activities as soon as two weeks after your accident, depending on the severity of your injury and the progress of your physical therapy. For the greatest outcomes, it is essential that you seek medical attention as soon as possible.

Best AC Joint Exercises

Initially, all workouts should be directed and monitored by a trained professional. The following are examples of AC joint recovery exercises:

  • Neck rotation
  • Shoulder rolls
  • Neck stretches
  • Shoulder blade squeeze
  • Lying-down shoulder flexion
  • Standing shoulder extension
  • Goalpost stretch
  • Shoulder blade squeeze

If you are considering beginning an exercise program for AC joint rehabilitation, it is critical that you obtain expert counsel from a physical therapist first.

How In Motion O.C. Can Help With AC Joint Separation

In Motion O.C. is a leading physical therapy clinic that has cutting-edge technology and equipment. Our physical therapists are the finest in the field, and they have helped hundreds of people who have suffered from AC joint ailments throughout the years. See for yourself what our patients have to say about us on Yelp, where we were ranked #1 for physical therapists in the whole US. We are the number one choice for any physical issues resulting from sports, trauma, or health-related conditions.

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* Dr Natalie Thomas, PT, DPT, has evaluated the content on this page concerning physical therapy for the AC joint.


The acromioclavicular joint, often known as the AC joint, is a joint that is found in the shoulder girdle (the collar bone and shoulder blade that support the shoulder joint). An AC joint injury is a type of shoulder injury that occurs at the top of the shoulder. It occurs where the front of the shoulder blade (acromion) joins to the collarbone, which is called the acromion process (clavicle). The most common cause of an AC joint injury is trauma, such as a fall that occurs directly on the outside of the shoulder.

Injuries to the AC joint are more prevalent in those less than 35 years old.

These injuries are more common among younger athletes who participate in sports such as football, motorcycling, skiing, and ice hockey, among other activities.

Physical therapists are experts in the movement of the body.

For an evaluation, you can make contact with a physical therapist directly. Find a PT is a website that can help you locate a physical therapist in your region. Find a Physical Therapist in Your Area!

What Are Acromioclavicular Joint Injuries?

The AC joint is held together by four ligaments that connect the two bones of the joint. When an injury to the AC joint develops, the ligaments of the joint are strained. As a result of this tension, some degree of joint separation occurs. There are two forms of AC joint injuries: traumatic and overuse injuries. Traumatic injuries are the most common type. AC joint damage as a result of a traumatic event. It is possible to sustain this form of damage when the joint is disturbed. The ligaments that connect the two bones of the joint are overstretched as a result of the excessive stretching.

It is distinct from a shoulder dislocation, which affects the ball-and-socket joint of the shoulder.

Examples include the following:

  • A football player who gets tackled
  • A cyclist who is involved in a crash A worker who has fallen from a ladder

An opponent tackles a football player, and a cyclist collapses. Employee who is injured after falling off of a scaffolding

  • Heavy weightlifting (bench presses and military presses) is recommended. Working in physical jobs where the arms must be extended over the head is required

How Does It Feel?

Following an injury to the AC joint, you may experience the following symptoms:

  • Generalized shoulder discomfort and swelling
  • Swelling and stiffness around the AC joint
  • Loss of shoulder strength
  • A visible lump above the shoulder
  • And a noticeable bulge above the shoulder blade When laying on the affected side, there is discomfort. loss of shoulder range of motion When you move, you may hear or feel a “popping” sound or the sensation that your shoulder “catches.” Discomfort associated with regular activities that put a strain on the AC joint Lifting items over your head, stretching across your body, or carrying heavy goods at your side are all examples of such actions.

How Is It Diagnosed?

A physical therapist can identify an AC joint injury by doing a shoulder exam on the patient. You will be evaluated thoroughly by your physical therapist in order to determine the extent of your injury and to discover all of the contributing causes. They will begin by conducting an interview with you in order to learn about your medical history. They may find it beneficial if you complete out paperwork prior to your first appointment. It is likely that the interview will grow more specialized to your shoulder’s condition in the future.

  • What happened to cause your injury? What steps have you made to manage the problem, such as seeing other health-care professionals? Have you had imaging (X-ray, MRI, or other testing) and gotten the results of those examinations? What are the symptoms you are experiencing right now? What changes have you noticed in your normal day and activities? Does your body experience any discomfort, and if so, where and how intense is your discomfort. Does the intensity of the pain change throughout the day? Do you find it difficult to participate in any activities? What kinds of activities are you unable to participate in

It is with this information that the physical therapist may have a better understanding of what you are experiencing. This information also aids in determining the path of your physical exam. The physical examination will differ based on the results of your interview. This will usually begin with a physical examination of the area where your symptoms are occurring as well as any movements or postures that produce pain. Additionally, your physical therapist may assess other parts of your body that may have changed as a result of the difficulties with your shoulder functionality.

  • Maintain awareness while you raise your arm and shoulder overhead and when performing other reaching exercises. Examine the range of motion and strength of your shoulder
  • Other parts of the body should be checked if necessary. This will aid in determining whether or not further sections of your body require therapy in order to enhance your condition. Try to feel about your shoulder and the AC joint with a gentle but skilled hand to pinpoint exactly what is causing the discomfort.

Your physical therapist will talk with you about the findings of their investigation. They will collaborate with you to build a program that is tailored to your individual requirements and goals, as well as to assist you in healing. Occasionally, your physical therapist may recommend that you undergo diagnostic imaging. The use of ultrasound, X-ray, or magnetic resonance imaging (MRI) can assist in confirming the diagnosis and determining the severity of the damage.

How Can a Physical Therapist Help?

Your physical therapist will create a treatment plan to assist you in returning to your intended activities in a safe manner.

The following may be included in your treatment plan:

  • Patient education is important. During your physical therapy session, your physical therapist will educate you on your AC joint and shoulder issue. They will work with you to discover any external variables that may be contributing to your discomfort, such as the number and type of workouts and activities you engage in on a daily basis. Your physical therapist will prescribe modifications to your activity, as well as pain management strategies. Your physical therapist will take care of your discomfort. In some cases, applying ice to the afflicted region may be necessary, among other things. They may also suggest that you modify some of the activities that are causing you discomfort. Physical therapists are professionals in the field of prescription pain-relieving medications. Exercises that improve range of motion can help to lessen or eliminate the need for medications, including opioids. The AC joint and shoulder’s range of motion may be restricted, resulting in higher stress on the shoulder joint. Self-stretching techniques may be taught to you by your physical therapist. Manual therapy can assist to relieve stress and restore normal mobility to your affected joints
  • It can also help to speed the healing process. It is possible that your physical therapist will use hands-on techniques to gently manipulate your muscles and joints. These strategies assist in the improvement of mobility. Manual treatment may also be used by your physical therapist to help your shoulder region into a less stressful movement pattern
  • Muscle strength may also be improved. It is possible that muscle imbalances or weaknesses will contribute to difficulties with the AC joint and shoulder. They can also cause symptoms to persist for an extended period of time. The severity of your injury will determine how your physical therapist will build a safe resistance program to assist you in recovering from your injury. Resistance equipment in the clinic and exercises to strengthen your core are examples of exercises that may be prescribed (midsection). You can begin doing exercises while laying down on a table, or while lying down on your bed or the floor at home. After that, you can go to exercises that are performed while standing. The exercises recommended by your physical therapist will be determined by your diagnosis, age, and medical condition (if applicable). When it is safe for you to exercise on your own at home or at a gym, they will assess whether functional training is necessary. Following an improvement in your discomfort, strength, and range of motion, functional training can assist you in safely returning to more demanding tasks. It is critical to educate your body safe, regulated motions in order to reduce the amount of stress placed on the AC joint and shoulder. Your physical therapist will design a series of activities to assist you in learning how to utilize and move your body in the most efficient and safe manner possible. Retraining your actions and placement when throwing, swinging a racket, raising items over your head, or carrying out other daily tasks are examples of such techniques

Can This Injury or Condition Be Prevented?

A variety of severe AC joint injuries can occur, and it can be difficult to prevent many of them. But there is plenty that can be done to avoid the chain of events that leads to overuse injuries from occurring. Physical therapists can aid in the prevention of overuse injuries by doing the following:

  • Educating you on how to safely carry goods from above while at work
  • When performing overhead resistance training or sports activities, appropriate form should be demonstrated. assisting you in maintaining overall shoulder strength and mobility so that you may safely do jobs

If you are experiencing chronic, consistent, or increasing symptoms, see a physical therapist as soon as possible.

What Kind of Physical Therapist Do I Need?

Physical therapists are educated and trained to treat a wide range of diseases and injuries, which they get via clinical practice and study. You might want to think about the following:

  • Individuals suffering from orthopedic or musculoskeletal (muscle, bone, and joint) ailments should seek the services of a physical therapist with specific training in these areas. Physical therapy specialists or physical therapists who have completed a residency in orthopedic physical therapy or sports physical therapy are also examples of this type of physical therapist. This physical therapist will have advanced knowledge, expertise, and abilities that will be applicable to persons who are physically engaged in their daily lives.

Finding physical therapists with these and other certifications may be accomplished via the use ofFind a PT, an online service developed by the American Physical Therapy Association. This tool can assist you in your search for physical therapists in your region who have specialized clinical knowledge. When looking for a physical therapist (or any other type of health care practitioner), here are some general guidelines:

  • Consult with family, friends, or other health-care professionals for advice. When you call a physical therapy facility to schedule an appointment, inquire about the physical therapists’ previous expertise in treating individuals with shoulder problems. Provide as much information as possible when describing your symptoms
  • Furthermore, be prepared to mention activities and movements that make your symptoms worse.

Find a Physical Therapist in Your Area!

Is this content helpful?

Thank you very much. Your feedback has been forwarded to the appropriate party. APT believes that consumers should have access to information that will assist them make educated health care decisions and prepare them for their appointment with a health care professional. The materials listed below provide some of the most up-to-date scientific research on the topic of physical therapy treatment for AC joint problems. They provide the results of recent research and provide an overview of the standards of practice in the United States and throughout the world, respectively.

  1. You may either read them or print a copy to bring with you to your health-care provider when you visit him or her.
  2. Acromioclavicular joint injuries: therapy based on scientific data.
  3. Journal of the American Academy of Orthop Surgery.
  4. Li X, Ma R, Bedi A, Dines DM, Altchek DW, Dines JS; Dines DM, Altchek DW, Dines JS.
  5. 2014;96(1):73–84.
  6. Summary of the article on PubMed.
  7. 2012;42(2):66–80.

Summary of the article on PubMed.

Pallis, K.L.

Svoboda, and B.D.

The incidence of acromioclavicular joint damage in young athletes has been studied.

Journal of Sports Medicine, 40(9):2072–2077.

PubMed contains millions of citations to biomedical literature, including citations to articles in the MEDLINE database maintained by the National Library of Medicine.

Symptoms Conditions Injury to the Acromioclavicular Joint Allison Mumbleau, PT, DPT, a board-certified clinical expert in sports physical therapy, is the author of this article.

P.T., DPT, clinical specialist in orthopedic physical therapy who has been board-certified. On behalf of the Academy of Orthopaedic Physical Therapy, Stephen F. ReischlPT, DPT, a board-certified clinical expert in orthopedic physical therapy, made the following statement:

AC Joint Sprain Exercises & Rehabilitation – Sports injury rehabilitation

Depending on the degree of the injury, rehabilitation exercises for an AC joint sprain or separation will be prescribed. Exercises should only be started once the ligaments have healed and you are no longer experiencing discomfort while performing your usual everyday activities. The following instructions are provided only for your convenience. We urge that you get expert assistance.

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First aid for AC joint separation injuries

To minimize pain and inflammation, total rest, immobilization, and constant administration of ice or cold therapy are essential at the beginning of the treatment.

When can I start AC joint sprain exercises?

Mobility exercises should only be performed if the shoulders are no longer in discomfort. For sprains of grades 1 and 2, the recovery time is typically 7-14 days. Grade 3 injuries are more commonly treated conservatively, without the need for surgery, but they will need an even longer time of rest and recuperation.

Scapular rhythm

Aside from that, exercises to restore scapular rhythm are also essential. In order for the shoulder blade and upper arm bone to move in sync, they must do so at the proper time. This rhythm is frequently disrupted in the wounded athlete.

AC joint sprain mobility exercises

The range of motion and mobility of the shoulder may be reduced if the shoulder has been immobilized for an extended length of time.

Pendulum exercises

Exercises for the Treatment of AC Joint SprainsRead More »”> Pendulum exercises can be started as soon as the ligament has healed and the discomfort is no longer a problem. While resting on your back or bent over, gently swing your arm forwards, backwards, and sides, as shown in the illustration opposite. Increase the range of motion in small increments. Swing your arm from side to side while you do this, and then repeat the process. Aim for a 90-degree turn in either direction when you are moving.

Front shoulder stretch

Stretch the front of the shoulder by placing one forearm on an immovable object (e.g. doorframe or corner of a wall) and slowly turning away from it to stretch the forearm. Hold the position for 10 to 20 seconds and then repeat the process three more times. A mild stretch should be felt at the front of the shoulder, but there should be no discomfort.

External rotation stretch

Then, with the upper arm at 90 degrees to your body and the elbow bent so that your hand points to the ceiling, a partner or therapist turns your arm at the shoulder so that the palm of your hand faces up.Hold the position for 20-30 seconds, then rest for 3-5 minutes and repeat the process three times. Stretches can be performed on a daily basis if there is no discomfort during, after, or the following day.

AC joint sprain strengthening

Strengthening the muscles around and supporting your shoulder can also be started as soon as the discomfort allows it to be done. If performing the exercises is unpleasant, you should take a little more time to relax.

Isometric exercises

Isometric strengthening should be used to begin with. This is defined as contracting the muscles without moving the body. AC Continue reading “Joint Sprain Exercises and Rehabilitation””> External and internal rotation, as well as abduction, should be included in the exercises (out to the side).

They can be executed with the assistance of a wall for resistance. Begin by exerting little pressure, and then gradually increase the amount of force you use. Hold for 10 seconds, then relax for 3-5 seconds before repeating as many times as you like.

Resistance band exercises for AC joint sprain

Exercises for the Treatment of AC Joint SprainsRead More »”> When it comes to shoulder strengthening, a resistance band is a wonderful piece of equipment to employ. Use a long length of resistance band to begin with, and if it becomes too easy, reduce or double the length of the band to increase the amount of resistance available.

Internal Rotation

In comparison to external rotation, this is the polar opposite movement. Pull your hand in, towards your stomach, while keeping your elbow at your side, beginning from the same position you started from. Note that you will need to turn around in order to add resistance to the exercise, so that you are dragging the band from your side across your body instead of up and down your body.

External rotation

This may be accomplished by securing the band to something secure, holding one end, and keeping the upper arm locked against the body with the elbow bent as shown. Pulling the band will cause the hand and forearm to travel away from the body, while maintaining the elbow against your side will keep the elbow against your side. Alternatively, hold the band between the hands with the elbows at the sides and work both sides at the same time, drawing the shoulder blades back and in. Perform three sets of ten repetitions each, with a one-minute break in between each set.

Abduction/lateral raise

Stand on one end of the resistance band and hold the other end in your hand while using the resistance band. Pull your hand up to the level of your shoulder, keeping your elbow straight the entire time, being sure to maintain proper posture throughout. Perform three sets of ten repetitions once more. Using a little dumbbell, this exercise may be completed just as effortlessly.

Returning to sport

You should be able to go through your whole range of motion without any discomfort before returning to any form of sport after suffering an AC joint injury. When you return to contact sports, tape the joint around your shoulder to keep it safe. Extra protection can be provided by placing a circular piece of padding with a hole cut in the centre over the top of your shoulder. This can be held in place with the use of bandaging or a shoulder brace. Throughout the return to sports period, it is important to keep up with stretching, mobility, and strength training activities.

Rehabilitation of Acromioclavicular Joint Separations: Operative and Nonoperative Considerations

M. Cote and colleagues published Clinical Sports Medicine 29 (2010), pp. 213-228. Written by Russell Hanks, PT and COMT of Anchorage, Alaska, who is a Fellowship Candidate with the IAOM-US Fellowship Program. IAOM-US Fellowship Director Jean-Michel Brismée, PT, ScD, is a physical therapist and scientist. Separations of the acromioclavicular joint (ACJ) account for roughly 9% of all shoulder girdle injuries seen in sports medicine and orthopedic offices. 1-3 While Grades I and II ACJ separations respond well to conservative therapy and Grades IV, V, and VI necessitate surgical intervention, there is substantial debate about whether Grade III separations should be treated surgically or nonoperatively in most cases.

  • Grade IA grade I separation is characterized by a sprain of the ACJ ligaments that does not result in clavicle displacement, resulting in a mild insult to joint stability in most cases.
  • The absence of discomfort when the arm is at the patient’s side and while doing self-care activities are the requirements for releasing the patient from the sling.
  • Internal rotation, horizontal adduction, and end range shoulder flexion are all improved slowly at this point in the program.
  • Strengthening exercises are started right once, and special care is paid to decreasing discomfort.
  • Exercising with a closed chain is a word used to describe workouts in which the distal section is not moved.
  • Closed chain motions include exercises such as scapular clocks, isometric low rows, and scapular protraction/retraction against a wall (see Figures 1-4), among others.
  • FIGURE 4: Scapular Protraction in opposition to the wall When the patient is able to voluntarily extend their arm through forward flexion without experiencing discomfort, open chain and isotonic motions can be initiated.
  • Return to exercise can begin as early as two weeks after the demonstration of pain-free mobility relevant to the activity being performed.

5-9) Illustrations 5, 6, and 7 3-level rowing with isotonic resistance Figure 8 Prone Physioball TFigure 9 Prone Physioball T ACJ separation in the prone position (not the coracoclavicular ligaments) is grade II and entails ripping of the ligaments (not the coracoclavicular ligaments) as well as possibly greater anteroposterior translation of the clavicle.

  1. It is necessary to begin scapular strengthening to address the possibility of anterior and posterior translation of the clavicle.
  2. For the reasons described above, it is preferable to begin closed chain strengthening as soon as possible after a Grade I injury.
  3. In addition to the 3:00 and 9:00 positions, scapular clocks may be done in those locations by internally or externally twisting the fingers into those positions and then conducting protraction and retraction of the scapulae.
  4. It is necessary to integrate the combined movements of the UE and rowing to advance scapular retraction.
  5. The LE and trunk motions are commenced in order to create naturally occurring shoulder movements with the UE5, 6 and other muscle groups in order to increase kinetic chain function (Figures 10-14).
  6. The inclusion of horizontal abduction, external rotation, and prone horizontal extension with the arm at 100 degrees can be introduced without resistance at first, and then completed to exhaustion as the patient’s tolerance for forward flexion increases (figures 8-9).
  7. acromioclavicular and coracoclavicular ligaments are completely torn apart in Grade III ACJ separations, resulting in full superior displacement of the clavicle.

Immobilization is fairly common during the acute phases of this separation, but patients are advised to use a sling as little as possible as long as their symptoms allow and to begin rehabilitation as soon as possible.

Although the authors advocate 6 to 12 weeks of rehabilitation before returning to activities or considering surgical intervention, they do state that failure to observe significant improvement in function after 6 weeks is typically indicative of the necessity for surgical intervention.

Because the degree of tissue stress associated with Grade III separations is larger than that associated with Grades I and II separations, pain and inflammation are often more severe and must be handled more aggressively.

It is essential for successful nonoperative therapy that the scapula is under good control.

7 Braces that aid in scapular retraction are very suggested in this situation.

It is difficult to put on and take off this brace without help, which might result in poor tolerance.

Other options include the S3 brace, which is a shirtlike compression device that is secured with adjustable neoprene and Velcro straps and is designed to promote a retracted position of the scapula.

Classes IV, V, and VI Anatomic coracoclavicular reconstruction is used to treat grades IV, V, and VI of the clavicle fracture (ACCR).

There are a variety of factors contributing to this, including the fact that these patients are often older than 55 years old and engaged in activities that exert a modest strain on the shoulder, among others.

Because of the diagnostic criteria used to differentiate between a grade III and a grade V separation, it is possible to have a false-negative result.

1 It is possible to diagnose grade V in situations when clavicular displacement exceeds 100 percent, regardless of whether the displacement is greater than or equal to the 300 percent threshold that characterizes a real grade V.

The purpose of this surgery is to restore the anatomy of the joint and to make it more stable again.

Each tunnel is fixed in place by an interference anchor that is inserted into it.

the numbers 8 and 9 Preoperatively, patients are trained on the proper use of a brace and shown a home exercise regimen that includes wrist/hand and elbow strengthening exercises.

A few days after this, the patient begins rehabilitation with active aided range of motion exercises in all planes of movement, with caution focused on end range motions, internal rotation, and cross body adduction, depending on the patient’s tolerance for these activities.

At 8 weeks, the emphasis is on scapular exercise and kinetic chain activity, with the rest of the program following.

Figures 15, 16, and 17.

Figure 17: Assisted elevation using a pulley system Figure 18: Supine assisted flexion with the help of a partner Following surgery, the author’s own experience has been that ROM limits are negligible at 10 weeks postoperatively.

They also believe that limits in mobility following surgery are due to the mechanics of the ACJ rather than a constraint in the GHJ capsule structure.

The study of anatomy, pathoanatomy, and biologic healing is required in order to develop rehabilitation recommendations.

The difficulty comes in determining the severity of the situation.

The IAOM was established with the goal of teaching diagnostic tests and therapy.

We are well aware that procedures are insufficient.

The Institute of Applied Occupational Medicine (IAOM) teaches structural diagnosis, functional diagnosis, biopsychosocial evaluation, basic activation, neural mobilization, strategic communication as a clinical tool, and techniques for sensory motor control rehabilitation.

In addition to what has been provided in this article, the International Association of Orthopaedic Medicine (IAOM) recommends that any end range postures for an unstable joint be avoided.

In order to enhance stability in the GHJ and AC joint, it is important to do exercises with a retracted scapula and movements in the scapular plane.

If the instability has been there for a long period of time, it is probable that there are many problems at play.

When working with overhead athletes and throwers, we must emphasize the importance of core and hip strength, which allows for a reduction in pressures via the shoulder joint and arm.

Early on, focus on endurance and control, then progress to tendon hypertrophy by performing hundreds of reps on a single set.

As you get closer to your functional/athletic return, start incorporating more power and strength exercises into your routine.

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As soon as they realize what it is for, they are more likely to buy into what you are doing, to establish faith in your capacity to help them, and to relax in the knowledge that you have a strategy to assist them in returning to play and function.

Rockwood CJ, Williams G, Young D.

Among those who have contributed to this volume are CJ Rockwood and FA III Matsen.

This is the second edition.

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Evaluation and treatment of acromioclavicular joint injuries.

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Acromioclavicular separations of grade III are managed in a practical manner.

The Kinesiology of the Human Body, Steindler A.

Thomas; 5McMullen J, Uhl TL; Springfield (MA): Charles C.

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Rehabilitation using a closed chain for the upper and lower extremities.

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Carbone, and F.

In individuals with persistent type III acromioclavicular dislocation, scapular dyskinesis and SICK scapula syndrome have been seen.

8 SA Rodeo, SP Arnoczky, PA Torzilli, and colleagues Tendon healing in the confines of a bone tunnel.

The Journal of Bone and Joint Surgery of the United States of America, Volume 75, Number 12, December 1993, pages 1795–803.




Compared to healing to a cancellous trough, tendon repair to cortical bone is more effective.

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Wisdom MB, Uhl TL, Mattacola CG, and colleagues During shoulder workouts, the influence of limb support on muscle activation was investigated.

J Shoulder Elbow Surg 2004;13(6):614–20; abstract available online. 11Lister JL, et al. Scapular stabilizer activity during Bodyblade, cuff weights, and Thera-band use. Journal of the American Medical Association. Athlete’s Sport Rehab. 2007 Feb; 16(1): 50-67.

AC Joint Problems

When two bones in the shoulder come together, it is known as the acromioclavicular joint, or AC joint. The collarbone, sometimes known as the clavicle, is one of these bones. Actually, the second bone is part of the shoulder blade (scapula), which is the large bone behind the shoulder that also forms a component of the joint that connects the two bones together. In orthopedics, the acromion refers to the part of the shoulder blade that connects to the clavicle. As a result, the AC joint is defined as the point at where the clavicle joins the acromion.

Cartilage is the white tissue between the bones that lets them to glide on each other like Teflon on two ball bearings.

What types of conditions occur at the AC joint?

There are a variety of disorders that can affect the AC joint, but the most prevalent are arthritis, fractures, and separations of the joint. An arthritic joint is a disease marked by the loss of cartilage in the joint, which is essentially wear and tear of the smooth cartilage that permits the bones to move smoothly in their joint space. It is similar to arthritis in other joints of the body in that it is characterized by pain and swelling, which worsens with exercise. Over time, the joint can get worn down and enlarged, with spurs growing around it to further complicate matters.

Achieving a cross-body reach for the other arm exacerbates arthritis in the AC joint.

AC joint wear and tear is also common in runners.

How is arthritis of the AC joint treated?

There is no method to restore cartilage to a joint that has lost it due to wear and tear. Because of this, one of the most effective ways to cure arthritis is to adapt your activities in order to avoid aggravating the illness. This does not imply that certain activities should be avoided altogether, but it may imply that they be performed less frequently or with less intensity in certain instances. In order to exercise their pectoralis muscle (which has been made stronger by bench press), weight lifters may perform a lift known as a butterfly, which does not appear to irritate the joint as much as a full bench press, or they may bench press only three quarters of the way down instead of doing a full bench press.

The application of ice to the joint helps to reduce the pain and inflammation associated with the joint.

Ice should be used after sporting activities, and if the joint is really painful, ice should be applied on a daily basis, or as frequently as every two hours if necessary.

Ice massage may be quite effective since the joint is so tiny, and paper cups filled with water and placed in the freezer form excellent ice cones for massaging the joint.

Ibuprofen (Advil or Motrin), naprosyn (Aleve), Feldene, Clinoril, Daypro, Indocin, and other drugs are examples of anti-inflammatory medications that are similar to aspirin but do not need to be taken as regularly as aspirin, for example.

What can be done if those treatments do not work?

If rest, ice, medicine, and changing your activities do not alleviate your symptoms, the next step is a cortisone injection to relieve your pain. One shot into the joint can sometimes completely eliminate the pain and swelling, but the impact is unpredictable and may not persist indefinitely. Before considering surgery, it is common practice to provide no more than one or two cortisone shots. If none of these therapies prove effective, surgical intervention may be considered. Because the discomfort is caused by the ends of the bones rubbing against each other, the therapy consists of the removal of a section of the end of the collarbone from the affected area.

Using an arthroscopic approach, the procedure can be performed through a single small incision about an inch long, or it can be performed through numerous small incisions using a different technique.

In the majority of situations, the patient can return home the same day as the procedure while wearing an arm sling (see illustration).

It takes around four to six weeks to restore full range of motion, and another few weeks to begin restoring strength.

What are the results of AC joint surgery?

The majority of patients get great pain relief following this procedure, and approximately 95 percent are able to return to their pre-injury level of activity and sports participation. There are rarely problems, and the majority of patients are really pleased with the outcome. The danger of infection exists at all times; however, it is quite unlikely. It is possible for a patient to have tiredness and pain when performing heavy lifting or exercising if their shoulder is not in good health. The majority of patients, on the other hand, are really delighted with the operation and are able to be more active than they were before it.

What is an AC joint separation?

Separation of the AC joint indicates that the ligaments have been ripped and the collarbone no longer lines up with the acromion. Ligaments are tight, sinewy tissues that function as tethers to tie the bones together, just like a tether holds a pair of shoes together. When such ligaments are strained or damaged, the resulting pain can be excruciating. When an AC separation occurs, the ligaments are injured in varying degrees of severity. The severity of the injuries is determined by which ligaments have been ripped and how badly they have been torn.

A grade 2 injury is characterized by damage to the ligaments surrounding the AC joint as well as to the other ligaments that help to support the joint in question.

The coracoclavicular ligaments are the name given to these ligaments.

A lump at the AC joint can occur if the collarbone and acromion are not aligned properly as a result of the stretching of these bones.

Coracoclavicular ligament damage is classified as grade 3 when the ligaments that connect the collarbone to the shoulder blade are fully ruptured. Consequently, the collarbone no longer aligns with the acromion, resulting in a malformation at the joint.

What is the treatment for AC joint separation?

These can be quite painful injuries, and the first step in treating them is to alleviate the discomfort. A sling is the most effective way to immobilize the arm, apply an ice pack to the shoulder for 20-30 minutes every two hours, and take pain medication. The severity of the separation is generally inversely related to the intensity of the pain. It is critical to begin moving the fingers, wrist, and elbow as soon as the pain begins to lessen in order to avoid stiffness in the joints. Following that, it is critical to initiate shoulder mobility in order to avoid astiff or “frozen” shoulder.

Typically, when the pain subsides, you will notice that you are able to move it more freely, and this will not harm or impair the healing process.

A grade 1 takes between 10 and 14 days, whilst a grade 3 takes between six and eight weeks to complete.

When is surgery indicated?

The good news is that surgery is not required for the vast majority of grade 1, 2, and 3 injuries. In most cases, even grade 3 injuries permit a return to full activity with little restrictions. The great majority of people do not require surgical treatment for this problem, despite the fact that some surgeons do advocate it for high-caliber players who throw baseballs for a livelihood. There are a few unusual forms of this injury in which the collarbone is elevated above the rest of the body and virtually sticks through the skin.

The advantage of this procedure is that the deformity at the AC joint is repaired; nevertheless, there is a scar on the shoulder as a result of the procedure.

The disadvantages of surgery include the possibility of infection, a longer period to regain full function, and, in rare circumstances, ongoing discomfort after the procedure.

How to Solve AC Joint Pain in Your Shoulder

When it comes to getting your body back on track, Rachel Tavel is a Doctor of Physical Therapy (DPT) as well as a Certified Strength and Conditioning Specialist (CSCS). She understands what it takes to get your body back on track. Her weekly ideas on how to feel better, become stronger, and exercise smarter will be sent to you in this weekly series. You’re in the gym, going about your business, when you suddenly feel a severe ache in your shoulder after performing a shoulder press. Whatever occurred, you aren’t sure what it was, but you are certain that it didn’t feel nice.

  1. In the upper arm, the AC joint is created by the acromion process of the scapula and the clavicle, two of the bones that serve to make up the shoulder girdle.
  2. The joint is made up of two flat surfaces that are kept together by ligaments, with a fluid-filled bursa sandwiched in between the two flat surfaces.
  3. It is also possible that the ligaments that hold the joint together have been sprained.
  4. AC joint sprains are a common injury that can occur in varied degrees of severity.
  5. To their advantage, most AC joint discomfort is the consequence of overuse of the joints and poor body mechanics, and it may be managed conservatively with rest, ice and exercise, with no need for surgical intervention.

This material has been imported from another source. Visiting their website may allow you to access the same stuff in a different format, or it may provide you with even more information than you could get elsewhere. Your next move:

  1. Exercises including resisted external and internal rotation will help to strengthen the rotator cuff muscles (focusing on the external rotation). Use a resistance band or tiny dumbbells (no more than 2 to 5 pounds) while lying on your side to do this. Increase or decrease the resistance such that you feel a good burn in your muscles after executing 2 to 3 sets of 10 repetitions. Make sure your shoulder blade is always down and back when you’re playing
  2. Strengthen the serratus anterior, which is a scapular protractor and stabilizer. Starting in the quadruped posture or, if pain-free, a modified push-up position is the best way to go about it (on your forearms). Slowly push the shoulder blades away from each other while supporting yourself with your body weight to get the desired result. Continue to hold this prolonged position with a neutral spine for around 10 seconds before slowly releasing yourself from it. Work on scapular alignment by doing the exercise 5 to 10 times. When performing any sort of resistant upper body workout, it is common for AC joint pain to occur as a result of permitting your shoulders to translate forward too much. Make use of a wall to provide a tactile indication to assist you in keeping your shoulder blades down and back while you are standing. Try walking away from the wall and seeing if you can keep this position with your rows, shoulder extension, and external/internal rotation.

It’s important to remember that you shouldn’t keep your problems to yourself. If you’re having a lot of discomfort and are unable to utilize your shoulder for your normal daily activities, you should consult an orthopedist or a doctor of physical therapy. Dr. Rachel Tavel, PT, DPT, CSCS is a physical therapist and doctor of physical therapy. She is a Doctor of Physical Therapy and Certified StrengthConditioning Specialist who also writes about health and fitness. Dr. Rachel Tavel is a PT at Shift Wellness in New York City where she also works as an exercise physiologist.

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