Acromioclavicular Separation

with Rehab

ExitCare ImageThe acromioclavicular joint is the joint between the roof of the shoulder (acromion) and the collarbone (clavicle). It is vulnerable to injury. An acromioclavicular (AC) separation is a partial or complete tear (sprain), injury, or redness and soreness (inflammation) of the ligaments that cross the acromioclavicular joint and hold it in place. There are two ligaments in this area that are vulnerable to injury, the acromioclavicular ligament and the coracoclavicular ligament.

SYMPTOMS

  • Tenderness and swelling, or a bump on top of the shoulder (at the AC joint).

  • Bruising (contusion) in the area within 48 hours of injury.

  • Loss of strength or pain when reaching over the head or across the body.

CAUSES

AC separation is caused by direct trauma to the joint (falling on your shoulder) or indirect trauma (falling on an outstretched arm).

RISK INCREASES WITH:

  • Sports that require contact or collision, throwing sports (i.e. racquetball, squash).

  • Poor strength and flexibility.

  • Previous shoulder sprain or dislocation.

  • Poorly fitted or padded protective equipment.

PREVENTION

  • Warm-up and stretch properly before activity.

  • Maintain physical fitness:

  • Shoulder strength.

  • Shoulder flexibility.

  • Cardiovascular fitness.

  • Wear properly fitted and padded protective equipment.

  • Learn and use proper technique when playing sports. Have a coach correct improper technique, including falling and landing.

  • Apply taping, protective strapping or padding, or an adhesive bandage as recommended before practice or competition.

PROGNOSIS

  • If treated properly, the symptoms of AC separation can be expected to go away.

  • If treated improperly, permanent disability may occur unless surgery is performed.

  • Healing time varies with type of sport and position, arm injured (dominant versus non-dominant) and severity of sprain.

RELATED COMPLICATIONS

  • Weakness and fatigue of the arm or shoulder are possible but uncommon.

  • Pain and inflammation of the AC joint may continue.

  • Prolonged healing time may be necessary if usual activities are resumed too early. This causes a susceptibility to recurrent injury.

  • Prolonged disability may occur.

  • The shoulder may remain unstable or arthritic following repeated injury.

TREATMENT

Treatment initially involves ice and medication to help reduce pain and inflammation. It may also be necessary to modify your activities in order to prevent further injury.

Both non-surgical and surgical interventions exist to treat AC separation. Non-surgical intervention is usually recommended and involves wearing a sling to immobilize the joint for a period of time to allow for healing.

Surgical intervention is usually only considered for severe sprains of the ligament or for individuals who do not improve after 2 to 6 months of non-surgical treatment. Surgical interventions require 4 to 6 months before a return to sports is possible.

MEDICATION

  • If pain medication is necessary, nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medication for 7 days before surgery.

  • Prescription pain relievers may be given by your caregiver. Use only as directed and only as much as you need.

  • Ointments applied to the skin may be helpful.

  • Corticosteroid injections may be given to reduce inflammation.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used prior to performing the stretching and strengthening activities prescribed by your caregiver, physical therapist or athletic trainer. Use a heat pack or a warm soak.

SEEK IMMEDIATE MEDICAL CARE IF:

  • Pain, swelling or bruising worsens despite treatment.

  • There is pain, numbness or coldness in the arm.

  • Discoloration appears in the fingernails.

  • New, unexplained symptoms develop.

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES – Acromioclavicular Separation

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

ExitCare Image ROM – Pendulum

  • Bend at the waist so that your right / left arm falls away from your body. Support yourself with your opposite hand on a solid surface, such as a table or a countertop.

  • Your right / left arm should be perpendicular to the ground. If it is not perpendicular, you need to lean over farther. Relax the muscles in your right / left arm and shoulder as much as possible.

  • Gently sway your hips and trunk so they move your right / left arm without any use of your right / left shoulder muscles.

  • Progress your movements so that your right / left arm moves side to side, then forward and backward, and finally, both clockwise and counterclockwise.

  • Complete __________ repetitions in each direction. Many people use this exercise to relieve discomfort in their shoulder as well as to gain range of motion.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETCH – Flexion, Seated

  • Sit in a firm chair so that your right / left forearm can rest on a table or countertop. Your right / left elbow should rest below the height of your shoulder so that your shoulder feels supported and not tense or uncomfortable.

  • Keeping your right / left shoulder relaxed, lean forward at your waist, allowing your right / left hand to slide forward. Bend forward until you feel a moderate stretch in your shoulder, but before you feel an increase in your pain.

  • Hold __________ seconds. Slowly return to your starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETCH – Flexion, Standing

  • Stand with good posture. With an underhand grip on your right / left and an overhand grip on the opposite hand, grasp a broomstick or cane so that your hands are a little more than shoulder-width apart.

  • Keeping your right / left elbow straight and shoulder muscles relaxed, push the stick with your opposite hand to raise your right / left arm in front of your body and then overhead. Raise your arm until you feel a stretch in your right / left shoulder, but before you have increased shoulder pain.

  • Try to avoid shrugging your right / left shoulder as your arm rises by keeping your shoulder blade tucked down and toward your mid-back spine. Hold __________ seconds.

  • Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTHENING EXERCISES – Acromioclavicular Separation

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Progress the resistance and repetitions only as guided.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does worsen, stop and make certain you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your clinician.

ExitCare Image STRENGTH – Shoulder Abductors, Isometric

  • With good posture, stand or sit about 4-6 inches from a wall with your right / left side facing the wall.

  • Bend your right / left elbow. Gently press your right / left elbow into the wall. Increase the pressure gradually until you are pressing as hard as you can without shrugging your shoulder or increasing any shoulder discomfort.

  • Hold __________ seconds.

  • Release the tension slowly. Relax your shoulder muscles completely before you start the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH – Internal Rotators, Isometric

  • Keep your right / left elbow at your side and bend it 90 degrees.

  • Step into a door frame so that the inside of your right / left wrist can press against the door frame without your upper arm leaving your side.

  • Gently press your right / left wrist into the door frame as if you were trying to draw the palm of your hand to your abdomen. Gradually increase the tension until you are pressing as hard as you can without shrugging your shoulder or increasing any shoulder discomfort.

  • Hold __________ seconds.

  • Release the tension slowly. Relax your shoulder muscles completely before you the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH – External Rotators, Isometric

  • Keep your right / left elbow at your side and bend it 90 degrees.

  • Step into a door frame so that the outside of your right / left wrist can press against the door frame without your upper arm leaving your side.

  • Gently press your right / left wrist into the door frame as if you were trying to swing the back of your hand away from your abdomen. Gradually increase the tension until you are pressing as hard as you can without shrugging your shoulder or increasing any shoulder discomfort.

  • Hold __________ seconds.

  • Release the tension slowly. Relax your shoulder muscles completely before you the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH – Internal Rotators

  • Secure a rubber exercise band/tubing to a fixed object so that it is at the same height as your right / left elbow when you are standing or sitting on a firm surface.

  • Stand or sit so that the secured exercise band/tubing is at your right / left side.

  • Bend your elbow 90 degrees. Place a folded towel or small pillow under your right / left arm so that your elbow is a few inches away from your side.

  • Keeping the tension on the exercise band/tubing, pull it across your body toward your abdomen. Be sure to keep your body steady so that the movement is only coming from your shoulder rotating.

  • Hold __________ seconds. Release the tension in a controlled manner as you return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH – External Rotators

  • Secure a rubber exercise band/tubing to a fixed object so that it is at the same height as your right / left elbow when you are standing or sitting on a firm surface.

  • Stand or sit so that the secured exercise band/tubing is at your side that is not injured.

  • Bend your elbow 90 degrees. Place a folded towel or small pillow under your right / left arm so that your elbow is a few inches away from your side.

  • Keeping the tension on the exercise band/tubing, pull it away from your body, as if pivoting on your elbow. Be sure to keep your body steady so that the movement is only coming from your shoulder rotating.

  • Hold __________ seconds. Release the tension in a controlled manner as you return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.