My repair technique preserves the end of the clavicle and rebuilds the key ligaments that are torn with new donor tissue. 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. Guidelines for rehab are determined through an understanding of anatomy, pathoanatomy and biologic healing. Ac joint pain exercises for shoulder rehab youtube. Here we explain the symptoms, causes, and treatment for ac joint sprains. An ac joint sprain is a relatively common sporting injury affecting the shoulder and is characterized by tearing of the connective tissue and ligaments of the acromio.
The fall injures the ligaments that surround and stabilize the ac joint. Conservative management of a type iii acromioclavicular separation. Shoulder separation and acromioclavicular joint injury. Acromioclavicular ac dislocation repair rehab protocol. You may know a sprained ac joint by its more common name a shoulder separation. While higher grade dislocations grade 4, grade 5, and grade 6 are more severe they only differ from a grade 3 by the severity and the direction of the displacement. Two of the most common ways people injure their ac joint is by falling on an outstretched arm or falling directly on the tip of the shoulder. Find pdfs of our most common rehabilitation protocols. Ac joint arthritis ac joint reconstruction arthroscopic bankart repair arthroscopic surgery information biceps tenodesis surgery frozen shoulder pectoralis major repair posterior bankart repair rotator cuff repair protocol shoulder. Immediate first aid for any ac joint injury is to apply the price principles of rest, ice, compression and elevation. Pain associated with an ac injury may be difficult to localize because of the complex sensory innervations of the joint. Conservative management of a type iii acromioclavicular. Shoulder separation and acromioclavicular joint injury dr. Another way to people sprain an ac joint is to run directly into something, such as a tree while skiing, with great force.
Most of my overhead athletes want their ac joint repaired as it restores length and stability to the shoulder. There is truly no right or wrong answer because this is a very hotly controversial area of modern day orthopedic treatment. Sports medicine physical therapy 6176439999 we use cookies and other tools to enhance your experience on our website and to analyze our web traffic. Ir behind the back, crossbody adduction, and endrange flexion are to be approached cautiously and within the patients own pain threshold. Conservative and operative rehabilitation from the physical therapy library of. Contact sports such as football, wrestling and rugby commonly see ac joint. The acromioclavicular joint or the ac joint is a diarthrodial joint with an interposed fibrocartilaginous meniscal disc connecting the clavicle with the acromion. Adults in their 20s suffer most ac joint injuries 43%.
Movement of the joint will help increase the healing and decrease scarring. Rehab shoulder ac joint reconstruction and protocol. Of the injuries to the shoulder girdle, 9% involve the ac joint. Acute acromioclavicular ac joint separation iiii protocol, 2010. In total there are 177 newly revised and expanded protocols for nonoperative and postoperative rehabilitation of the shoulder, elbow, hip, knee, foot, and ankle, plus exercise handouts and interval return to sport programs. Ac sprain university of miami sports medicine institute. A mild shoulder separation involves a sprain of the ac ligament that does not move the collarbone and looks normal on xrays. Walking or exercise bike in sling le resistance exercises if able to protect surgical area. Ac joint sprain shoulder separation ac injury physioadvisor. The joint joins your collarbone to your shoulder blade. 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. It can be due to trauma, such as joint dislocation of the acromioclavicular joint or degenerative conditions, such as osteoarthritis. Ac joint separation recovery time steven struhl md new. Physical therapy protocols boston shoulder institute.
A grade 3 ac joint separation is a true dislocation of the ac joint. Wear a sling to immobilize the shoulder and ease pain by taking the weight of the arm. The acromioclavicular joint, also known as the ac joint, is that bony bump you notice and feel on top of your shoulder. There is, however, a lack of evidence regarding rehabilitation protocols. 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. There are approximately 50,000 ac joint separations that occur each year in the us and most of them will be treated nonsurgically initially. Variances will be communicated by the surgeon directly to rehabilitation services. Conservative treatment is the first approach and this usually consists of rest, modifying activities in order to avoid pain, taking antiinflammatory medications, using a combination of heat and cold application, and formal physical therapy which may use modalities such as ultrasound.
An injury or sprain occurs when these ligaments become strained, overstretched or torn completely. An ac joint sprain is a relatively common sporting injury affecting the shoulder and is characterized by tearing of the connective tissue and ligaments of the acromioclavicular joint. Type i with only a sprain of the ac joint ligaments, no joint deformity is apparent during physical or radiographic examination. Stand upright and hold a stick in both hands, palms down. Postsurgical rehabilitation following acromioclavicular joint. Mechanism of injury the most common cause for a separation of the ac joint is from a fall directly onto the shoulder.
This injury commonly occurs from a direct blow to the shoulder such as a fall during sporting activity. We provide our patients with comprehensive, coordinated care from experts who understand the unique needs of women in sports. Kavanagh, pac this protocol provides general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of. Determining what to do with each ac joint sprain is relatively easy once you have determined its severity. Acromioclavicular separation brigham and womens hospital. Postsurgical rehabilitation following acromioclavicular. Acromioclavicular ac joint injury is a term used to describe an injury to the. It has an intraarticular synovium and an articular cartilage interface and is characterized by the various angles of inclination in the sagittal and coronal planes and by a disc.
Rehabilitation is an important part of the management of any grade separation of the ac joint. A careful and precise xray evaluation is critical in diagnosing the correct ac joint separation grade. Acromioclavicular ac joint reconstruction rehab protocol. Examination and presentation of acromioclavicular joint injuries. Mobility exercises can begin only once shoulder movement is painfree. The sports physical therapy service is an integral part of the sports medicine center and the department of. Most shoulder separations are actually injuries to the acromioclavicular ac joint. A more serious injury tears the ac ligament and sprains or slightly tears the coracoclavicular cc ligament, putting the collarbone out. In a shoulder separation also known as an acromioclavicular ac joint separation, the joint of the clavicle and the scapula is disrupted.
The rice protocol is the goto treatment for any ligament injury. A fibrous capsule surrounds the joint and there may be a. A mild shoulder separation involves a sprain of the ac ligament that does not move. Mazzocca, ms, mda, acromioclavicular joint ac separations are one of the most common injuries seen in. A grade i separation involves a sprain of the ac ligaments without clavicle. Kavanagh, pac this protocol provides general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement. The shoulder blade gives rise to a bony prominence known as the acromion. Shoulder separation exercises summit medical group. Acromioclavicular ac joint reconstruction rehab protocol general considerations do not elevate surgical arm above 70 degrees in any plane for the first 4 weeks postop activepassive range of motion. The joint is held together by several ligaments the acromioclavicular ligament and the coracoclavicular ligaments which provide stability to the joint. Type iii ac separations pose a controversial course of therapeutic management.
Gladstone and colleagues28 described a 4part physical therapy protocol for the treatmentofgradei,ii,andiiiacjointinjuriesinathletes. Ac joint sprains are often caused by a fall onto an outstretched arm. Shoulder dislocations and ac joint separations are often mistaken for each other. A shoulder separation is a fairly common injury, especially in certain sports.
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. Physical therapy guide to acromioclavicular joint ac joint. Sprains are the most common injury occurring at the ac joint, typically in. Wojcik, mspt, atcb, gregg gomlinski, mspt, cscsb, augustus d. An ac joint sprain or ac joint separation is when the acromioclavicular joint separates. Diagnosis and management of grade ii acromioclavicular joint. Commonly, injury happens when falling onto an outstretched hand or elbow, direct blows to the shoulder, or falling onto the point of the shoulder. The postoperative rehabilitation protocol for sternoclavicular joint reconstruction employed at the senior authors institution emphasizes avoidance of scapular protraction and retraction appendix 1. With this condition, there iusually pain that limits the motion ofthe arm. Acromioclavicular ac injuries are very common in contact sports rugby, wrestling, ice hockey, and football and the majority of these injuries are in the form of sprains. An acromioclavicular ac joint dislocation, or separated shoulder, is not truly an injury to the shoulder joint itself, but of the ligaments that attach the clavicle to the scapula.
Initially complete rest, immobilization and regular application of ice or cold therapy is important to reduce pain and inflammation. This treatment is usually done within the first 72 hours of injury. An ac joint injury will either be a minor injury grade 1 or grade 2, or a major injury grade. Ac joint separation recovery time and the return to active sports vary. The ac joint is where the collarbone clavicle meets the highest point of the shoulder blade acromion. A more serious injury tears the ac ligament and sprains or slightly tears the coracoclavicular cc ligament, putting the collarbone out of alignment to some extent with a smaller bump. Ac joint arthrosis, or osteoarthritis of the, acromioclavicular joint is most common in people who are middle aged. Postoperative shoulder ac joint reconstruction rehabilitation protocol from san francisco orthopaedic sports medicine surgeon dr. Nov 08, 2016 rehabilitation of ac joint separation injuries. Progress prone posterior shoulder girdle exercises. Core therapeutic exercises if able to protect surgical area.
Diagnosis and management of grade ii acromioclavicular joint separation anna kiner 236 the circle, queen elisabeth street, london se1 2jn, uk. Minimal tenderness and swelling may be present over the ac joint. Apr 23, 2018 these 3 exercises for ac joint pain are going to help you keep the shoulder moving and start to reeducate the neuromuscular system for proper aligned movement patterns thats going to set you up. An ac joint sprain or separation is often the result of falling with an outstretched arm. Acromioclavicular sprain rehabilitation program angelfire. Apply ice or cold therapy and compression wrap as soon as possible to reduce pain and swelling.
The ac joint is a resilient joint that can resist significant amounts of force before disruption. Physical therapy management of the patient with an acromioclavicular joint. Ac joint pain either from arthritis or osteolysis can be treated in many ways. The closed pack position for the ac joint is 90 degrees of shoulder abduction. This will normally be 714 days for grades 1 and 2 sprains. Ac joint sprain exercises sports injury rehabilitation. Ac joint separationsprain virtual sports injury clinic. The ligaments can be overstretched or in severe cases torn by falling on the shoulder or hitting the shoulder hard against another player or surface. Ibuprofenadvil 4 times a day for 3 days only if no allergies phase ii restore range of motion 24 days for grade i. Rehabilitation of acromioclavicular joint separations. The ac joint is the connection between the scapula shoulder blade and the clavicle collarbone. However, depending on the signs you have, your physiotherapist or doctor may suggest that some parts of the rice treatment should continue for more than 72 hours. The acromioclavicular joint is made up of the acromioclavicular ligament and coracoclavicular ligament near the shoulder at the outer part of the clavicle or the collarbone. A sternoclavicular joint sprain is a relatively rare sporting injury, characterized by tearing of connective tissue and or ligaments of the joint between the breast bone sternum and collar bone clavicle at the front top of the chest sternoclavicular joint figure 1.
An acromioclavicular joint separation, or ac separation, is a very frequent injury among physically active people. Prior to ac joint stabilisation surgery for ac joint separation injury, you are advised to visit your physiotherapist to make sure you are ready for your postop rehab. Frisbie memorial hospital gr iii acromioclavicular separation. The sports physical therapy service is an integral part of the sports medicine center and the department of physical and occupational therapy. Keeping your chin level, turn your head to the right, and hold for 15 to 30 seconds. The closed pack position of a joint is the the point at which the joint surfaces are maximally congruent, and the ligaments are most pulled taut i. The ac joint is a plane synovial joint comprised of the acromial process of the scapula and the lateral end of the clavicle. Interferential stim can be used with ice at the same time 3 nsaids a.
Rehabilitation of acromioclavicular joint injuries. Phase1focusesontheelim ination of pain and protection of the ac joint through sling immobilization 310 days, along with the prevention of muscular atrophy. Control inflammation and pain reduce swelling rehab. Postsurgical rehabilitation following acromioclavicular joint reconstruction ramin r. Turn your head to the left, and hold for 15 to 30 seconds. Gradually progress sport activities to unrestrictive participation continue stretching and strengthening program note well. 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. Sports medicine physical therapy rehabilitation protocols. Acromioclavicular joint injury shoulder separation beyond the basics, 20. Jun 06, 2016 an ac joint sprain or separation is often the result of falling with an outstretched arm. Grade 3 ac separation grade 3 ac joint separation steven. Continue deltoid and rotator cuff isometric exercises in multiple planes. Phase i control inflammation 12 days for grade i sprain, 23 days for grade ii goals. Use ice for 15 minutes per application to control pain and swelling.
Diagnosis and management of grade ii acromioclavicular. Jan 07, 2019 an ac joint separation, or ac joint sprain, is an injury to the ligaments which hold the acromioclavicular joint together at the top of the shoulder. The patient received acupuncture, joint mobilizations, palliative adhesive taping of the ac joint, active release technique, and progressive resisted exercises. Movement of the joint will help increase the healing and. Stretch your arms by lifting them over your head, keeping your arms straight.
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