Acromioclavicular Separation

What is Acromioclavicular Separation

Acromioclavicular separation is an injury to the small joint at the top of the shoulder (acromioclavicular jointor AC joint). The AC joint connects the outer tip of the collarbone (clavicle) to the top of the shoulder blade (acromion).

Two strong cords of tissue (acromioclavicular ligamentand coracoclavicular ligament) stretch across the AC joint to keep it in place. An AC joint separation happens when one or both ligaments stretch or tear, causing the joint to separate.

There are six types of separation. The type of separation that you have depends on how much the ligaments are damaged and how far the joint has moved out of place. The less severe types of separation are most common.

What are the causes?

Common causes of this condition include:

• A hard, direct hit (blow) to the top of the shoulder.
• Falling on the shoulder.
• Falling on an outstretched arm.

What increases the risk?

This condition is more likely to develop in male athletes under age 35 who participate in sports that involve potential contact, such as:

• Football.
• Rugby.
• Hockey.
• Cycling.
• Martial arts.

What are the signs or symptoms?

The main symptom of this condition is shoulder pain. Pain may be mild or severe, depending on the type of separation. Other signs and symptoms in the shoulder may include:

• Swelling.
• Limited range of motion, especially when moving the arm across the body.
• Pain and tenderness when touching the top of the shoulder.
• Pain when putting weight on the shoulder, such as rolling on the shoulder while sleeping.
• A visible bump (deformity) over the joint.
• A clicking or popping sound when moving the shoulder.

How is this diagnosed?

This condition may be diagnosed based on:

• Your symptoms.
• Your medical history, including your history of recent injuries.
• A physical exam to check for deformity and limited range of motion.
• Imaging tests, such as:
  • X-rays.
  • MRI.
  • Ultrasound.

How is this treated?

Treatment for this condition may include:

• Resting the shoulder before gradually returning to normal activities.
• Icing the shoulder.
• NSAIDs to help reduce pain and swelling.
• A sling to support your shoulder and keep it from moving.
• Physical therapy.
• Surgery. This is rare. Surgery may be needed for severe injuries that include breaks (fractures) in a bone, or injuries that do not get better with nonsurgical treatments. Surgery is followed by keeping your joint in place for a period of time (immobilization) and physical therapy.

Follow these instructions at home:

If you have a sling:

• Wear the sling as told by your health care provider. Remove it only as told by your health care provider.
• Reposition the sling if your fingers tingle, become numb, or turn cold and blue.
• Do notlet your sling get wet if it is not waterproof. Ask your health care provider if you can remove the sling for bathing and showering.
• Keep the sling clean.

Managing pain, stiffness, and swelling

• If directed, apply ice to the injured area.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Move your fingers often to avoid stiffness and to lessen swelling.

Driving

• Do notdrive or operate heavy machinery while taking prescription pain medicine.
• Ask your health care provider when it is safe for you to drive.

Activity

• Rest and return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do exercises as told by your health care provider.

General instructions

• Do notuse any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. Tobacco can delay healing. If you need help quitting, ask your health care provider.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

• Make sure to use equipment that fits you.
• Wear shoulder padding during contact sports.
• Be safe and responsible while being active to avoid falls.

Contact a health care provider if:

• Your pain and stiffness do not improve after 2 weeks.

Acromioclavicular Separation Rehab After Surgery

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do notbegin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your shoulder. These exercises also help to relieve pain, numbness, and tingling.

Exercise A: Pendulum

1. Stand near a wall or a surface that you can hold onto for balance.
2. Bend at the waist and let your left / right arm hang straight down. Use your other arm to keep your balance.
3. Relax your arm and shoulder muscles, and move your hips and your trunk so your left / right arm swings freely. Your arm should swing because of the motion of your body, not because you are using your arm or shoulder muscles.
4. Keep moving so your arm swings in the following directions, as told by your health care provider:
   • Side to side.
   • Forward and backward.
   • In clockwise and counterclockwise circles.

Repeat __________ times, or for __________ seconds per direction. Complete this exercise __________ times a day.

Exercise B: Flexion, standing

1. Stand and hold a broomstick, a cane, or a similar object with your hands. Place your hands a little more than shoulder-width apart on the object. Your left / right hand should be palm-up, and your other hand should be palm-down.
2. Push the stick down with your healthy arm to raise your left / right arm in front of your body, and then over your head. Use your other hand to help move the stick. Stop when you feel a stretch in your shoulder, or when you reach the angle that is recommended by your health care provider.
   • Avoid shrugging your shoulder while you raise your arm. Keep your shoulder blade tucked down toward your spine.
3. Hold for __________ seconds.
4. Slowly return to the starting position.

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

Exercise C: Flexion, seated

1. Sit in a stable chair so your left / right forearm can rest on a flat surface. Your elbow should rest at a height that keeps your upper arm next to your body.
2. Keeping your shoulder relaxed, lean forward at the waist and let your hand slide forward. Stop when you feel a stretch in your shoulder, or when you reach the angle that is recommended by your health care provider.
3. Hold for __________ seconds.
4. Slowly return to the starting position.

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

Strengthening exercises

These exercises build strength and endurance in your shoulder. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise D: Shoulder abduction, isometric

1. Stand or sit about 4–6 inches (10–15 cm) away from a wall with your right/left side facing the wall.
2. Bend your left / right elbow and gently press your elbow against the wall as if you are trying to move your arm out to your side. Gradually increase the pressure until you are pressing as hard as you can without shrugging your shoulder.
3. Hold for __________ seconds.
4. Slowly release the tension and relax your muscles completely before you repeat the exercise.

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

Exercise E: Internal rotation, isometric

1. Stand or sit in a doorway, facing the door frame.
2. Bend your left / right elbow and place the palm of your hand against the door frame. Only your palm should be touching the frame. Keep your upper arm at your side.
3. Gently press your hand against the door frame, as if you are trying to push your arm toward your abdomen.
   • Avoid shrugging your shoulder while you press your hand into the door frame. Keep your shoulder blade tucked down toward the middle of your back.
4. Hold for __________ seconds.
5. Slowly release the tension, and relax your muscles completely before you repeat the exercise.

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

Exercise F: External rotation, isometric

1. Stand or sit in a doorway, facing the door frame.
2. Bend your left / right elbow and place the back of your wrist against the door frame. Only the back of your wrist should be touching the frame. Keep your upper arm at your side.
3. Gently press your wrist against the door frame, as if you are trying to push your arm away from your abdomen.
   • Avoid shrugging your shoulder while you press your wrist into the door frame. Keep your shoulder blade tucked down toward the middle of your back.
4. Hold for __________ seconds.
5. Slowly release the tension, and relax your muscles completely before you repeat the exercise.

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

Exercise G: Internal rotation

1. Sit in a stable chair without armrests, or stand.
2. Secure an exercise band at elbow height at your left / right side.
3. Place a soft object, such as a folded towel or a small pillow, between your left / right upper arm and your body to move your elbow a few inches (about 10 cm) away from your side.
4. Hold the end of the exercise band so it stretches.
5. Keeping your elbow pressed against the soft object, move your forearm in, toward your abdomen. Keep your body steady so the movement is only coming from your shoulder.
6. Hold for __________ seconds.
7. Slowly return to the starting position.

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

Exercise H: External rotation

1. Sit in a stable chair without armrests, or stand.
2. Secure an exercise band at elbow height on your left / right side.
3. Place a soft object, such as a folded towel or a small pillow, between your left / right upper arm and your body to move your elbow a few inches (about 10 cm) away from your side.
4. Hold the end of the exercise band so it stretches.
5. Keeping your elbow pressed against the soft object, move your forearm out, away from your abdomen. Keep your body steady so the movement is only coming from your shoulder.
6. Hold for __________ seconds.
7. Slowly return to the starting position.

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