AC Joint Injuries

Shoulder

AC Joint Injuries

The acromioclavicular (AC) joint, also commonly called the shoulder separation, connects the collarbone to the shoulder blade (acromion process). This joint plays an important role in stabilizing the shoulder and allowing a wide range of motion. However, AC joint injuries are relatively common, especially among athletes and those involved in activities with high impact forces.

An AC joint injury refers to damage to the ligaments around the joint, or in severe cases, a fracture of the clavicle near the AC joint. These injuries can range from mild sprains to complete tears of the ligament, causing varying degrees of pain, instability, and limitations in shoulder movement.

What are the Symptoms?

The most common symptoms of an AC joint injury include:

Pain: Pain is the most prominent symptom, usually felt in the upper part of the shoulder, worse with movement, especially reaching up or across the body.
Tenderness: The area around the AC joint may be tender to the touch.
Swelling: Swelling and bruising are often present around the shoulder joint.
Decreased range of motion: Difficulty lifting the arm overhead or behind the back due to pain and instability.
Popping or snapping sensation: Some people may experience a popping or snapping sound when the injury occurs.
Visible deformity: In severe cases, a visible deformity or bump may be evident in the AC joint due to broken bone fragments (Hensley’s fracture).

What are the Causes & Risk Factor?

Several factors can contribute to AC joint injuries:

Direct impact: A forceful blow to the point of the shoulder, such as a fall on an outstretched arm or a direct hit during contact sports (soccer, rugby), can damage the AC ligament.
Falling: Falling on the shoulder or landing awkwardly with outstretched arms can cause AC joint injuries.
Repetitive overhead movements: Activities that involve repetitive overhead movements, such as weightlifting or throwing sports (baseball, tennis), can stress the AC joint ligament over time, causing microtears. and possible injury may occur.
Motor vehicle accidents: Car accidents, especially side impact collisions, can cause significant trauma to the shoulder and AC joint.

Predisposing factors of AC joint injuries

Some factors can increase your risk of AC joint injury:

Participation in contact sports: Sports such as football, rugby, hockey, and martial arts put athletes at high risk for falls and direct blows to the shoulder.
Weak core muscles: A weak core can put extra stress on the shoulder and AC joint during strenuous activities.
Previous shoulder injuries: Previous injuries to the shoulder joint or AC joint can weaken the structure, making them more susceptible to future injuries.
Osteoporosis: This condition weakens the bones, increasing the risk of fractures, including near the AC joint.

Diagnosis of AC joint injuries

A health care professional will examine your shoulder to:

Location and intensity of pain: They will palpate the AC joint and surrounding areas to identify the point of tenderness.
Range of motion: They will assess your ability to move your arm in different directions.
Stability tests: Specific tests may be done to check for abnormal movement in the AC joint, which suggests ligament damage.

Imaging tests are not always necessary but may be helpful in some cases:

X-rays: X-rays can help identify clavicle fractures near the AC joint.
MRI scan: In rare cases, an MRI scan may be used to look for soft tissue damage to the ligament if a complete tear is suspected.

Treatment options for AC Joint Injuries (continued)

Treatment of AC joint injuries depends on the severity of ligament damage. Here’s an overview of common treatment options:

Weight management: Losing weight, even a small amount, can significantly reduce stress on the hip joint and improve symptoms.
Pain management: Acetaminophen, ibuprofen, or other pain relievers can help manage pain and inflammation. Topical pain medications such as creams or gels may also provide relief.
Heat and cold therapy: Applying heat with a heating pad or warm compress can help relax tight muscles before activity, while applying a cold pack after activity can reduce pain and inflammation.
Assistive devices: Using a cane or walking stick can help reduce stress on the hip joint while walking.

Non-surgical treatment:

Rest: Avoiding activities that aggravate pain, especially those that involve overhead movement, is crucial for early healing.
Ice therapy: Applying an ice pack to the affected area for 15-20 minutes at a time, several times a day can help reduce pain and inflammation.
Pain medication: Over-the-counter pain relievers such as ibuprofen or acetaminophen can help manage pain and discomfort.
Sling mobilization: In some cases, wearing a sling for a short period of time (1-2 weeks) can help stabilize the joint and promote healing. However, prolonged immobilization can lead to stiffness, so early range-of-motion exercises are essential.
Physical Therapy: Physical therapy plays an important role in rehabilitation.
Pain management techniques: Strategies such as ultrasound therapy or electrical stimulation can be used to manage pain and promote healing.
Corticosteroid injection: In some cases, injecting corticosteroids around the AC joint can relieve pain and reduce inflammation. However, repeated injections are not recommended due to possible side effects.

Surgery:

Surgery for AC joint injuries is rarely necessary and is usually reserved for severe cases where a complete ligament tear with significant joint instability or a broken collarbone displaces a large piece of bone and needs to be fixed.
The type of surgery depends on the specific injury. This may include:
Arthroscopic surgery: A minimally invasive procedure using a camera and small instruments to repair torn ligaments.
Open surgery: In some cases, a traditional open incision may be necessary for complex repairs.

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