Pain > Acromioclavicular Joint Injuries
Acromicioclavicular (AC) Joint Injuries
Acromioclavicular (AC) joint injury is an injury
to the top of the shoulder, where the front of the shoulder blade
(acromion) attaches to the collarbone (clavicle).
AC joint injuries can be caused by a
traumatic event, such as falling directly on the outside of the shoulder,
or by repetitive overuse. Most AC joint injuries are common in
individuals younger than 35 years old, with males sustaining 500% more traumatic AC joint injuries than females.
Because younger athletes
are most likely to participate in high-risk and collision activities,
such as football, biking, snow sports, hockey, and rugby, that's why traumatic acromioclavicular joint injuries occur most often in this population.
AC joint injuries
can be identified and effectively treated by a senior physiotherapist, often
avoiding the need for surgery.
What Are Acromicioclavicular (AC) Joint Injuries?
There are total of four ligaments holding the 2 bones of the AC joint (the
acromion and the clavicle) together. Usually when an AC joint injury occurs,
these ligaments are stressed, resulting in some degree of joint
separation (and injury).
There are 2 types of injuries that can occur at the AC
- traumatic (high impact types such as sports, accidents, falls etc)
- overuse injuries (due to overuse over a period of time)
A traumatic AC joint injury occurs when there is a
disruption of the joint due to damaged ligaments holding the 2 bones of
the joint together. This injury is called a shoulder separation (in contrast to a shoulder dislocation, it involves the ball-and-socket joint of the shoulder).
Traumatic AC joint injuries are most common in individuals who
sustain a fall and land on the outside of the shoulder or onto a hand eg
- a rugby or soccer player who was tackled
- a bicyclist who crashed his/her bike
- a person who fell off a ladder/raised location
Traumatic AC joint injuries are graded from mild to severe based on
the amount of separation of the joint. Treatment of mild cases likely
will be provided and solved by a physical therapist; more severe cases may require
corrective shoulder surgery followed by post-surgery physiotherapy.
For the overused AC joint injury which occurs over time as
repeated, excessive stress is placed on the joint. Cartilage at the ends
of the acromion and clavicle bones protects the joint from daily wear
and tear. Over a period of time, the demand placed on this cartilage may be more
than it is capable of enduring, resulting in an overuse injury.
Significant wearing of the cartilage is known as arthritis.
joint injury is most common in individuals who perform tasks, such as
heavy weight lifting (eg bench press and military presses), or jobs that require
physical labor with the arms stretched over the head.
How Does an acromioclavicular joint injury 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
- A visible bump above the shoulder
- Pain when lying or sleeping on the injured side
- Decreased shoulder range of motion
- A popping/clicking sound or catching sensation with movement of the shoulder
- Discomfort with daily activities that stress the AC joint, like
lifting objects overhead, reaching across your body, or carrying heavy
objects at your side
How Is acromioclavicular joint injury Diagnosed?
Diagnosis of an AC joint injury starts with a thorough review of the
patient’s medical history, including specific questions regarding when
the pain began, what aggravates and relieves the pain.
Our senior physiotherapist will examine your shoulder and assess
different measures, such as
Then they will perform several
tests specific to your shoulder joint to examine the structures located
there. The senior physiotherapist may also ask you to briefly demonstrate the
activities or positions that causes or aggravates your shoulder pain. Other nearby areas, such
as your neck and upper back will also be examined to determine whether
they, too, might be contributing to your shoulder condition.
While an AC joint injury can usually be identified through a shoulder
examination, diagnostic imaging, such as ultrasound, x-ray, or MRI is
often used to confirm the diagnosis and determine the severity of the
How our senior physiotherapists can Help you
Once other conditions have been ruled out and an injury to the AC
joint is diagnosed, our senior physiotherapist will work with you to
develop an individualized plan tailored to your specific shoulder
condition and your goals.
There are many physical therapy treatments
that have been shown to be effective in treating this condition. Your
physical therapist may focus on:
Range of Motion. An injury to the
AC joint, whether traumatic or overuse, causes the joint to be
irritated, often resulting in swelling and stiffness, causing loss of
normal motion. Motions that are usually most difficult after an AC joint
injury are reaching across your body and lifting your arm directly
overhead. While it is important to regain your normal shoulder motion,
it is also important to allow your injury to heal without placing
excessive stress on the healing joint. They will
assess your shoulder range-of-motion and the severity of your shoulder injury, and establish a plan
that will balance joint protection and motion restoration.
Strength Training. After an injury, the surrounding
muscles will become weakened. All of the muscles near the shoulder and
elbow as well as those of the upper back, work together to allow for
normal, coordinated upper-body motion. That's why we need to re-balance the strength
of all the upper-body muscles to make sure the shoulder
joint is protected and moves efficiently. Our senior physiotherapist will
design an individualized exercise program to strengthen the muscles at
and around the shoulder, so that each muscle is able to properly perform
Manual Therapy. Physical therapists are trained in
manual (hands-on) therapy. If needed, your physical therapist will
gently move and mobilize your shoulder joint and surrounding muscles as
needed to improve their motion, flexibility, and strength. These
techniques can target areas that are difficult to treat on your own.
Pain Management. Our senior physiotherapist may recommend therapeutic modalities, such as cold therapy and heat therapy to aid in pain management.
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