AC JOINT INJURIES

AOSSM SPORTS TIPS

WHAT IS THE AC JOINT? symptom of the arthritis and not the long or arthroscopically using several primary cause of the pain. Motions small incisions. Regardless of the tech - The AC (acromioclavicular) joint is a which aggravate arthritis at the AC nique utilized, the recovery and results joint in the shoulder where the collar - joint include reaching across the body are about the same. Most patients have bone (clavicle) meets the shoulder toward the other arm. AC joint arthritis full motion by six weeks and return to blade (scapula). The specific part of is common in weight lifters, especially sports by 12 weeks. the scapula adjacent to the clavicle with the bench press, and (to a lesser is called the acromion, hence the extent) military press. AC joint arthritis WHAT IS AN AC name AC joint. This is in contrast may also be present when there are to the glenohumeral joint, the main rotator cuff problems. SEPARATION? “ball and socket” shoulder joint. When the AC joint is “separated” it HOW DO YOU TREAT means that the ligaments connecting WHAT KINDS OF PROBLEMS ARTHRITIS OF THE the acromion and clavicle have been OCCUR AT THE AC JOINT? AC JOINT? damaged, and the two structures no longer line up correctly. AC separations The most common problems that occur There is currently no way to replace can be anywhere from mild to severe, at the AC joint are arthritis, fractures the cartilage that is damaged by arthri - and AC separations are “graded” and “separations.” Arthritis is a condi - tis. As a result, the primary way to depending upon which ligaments are tion characterized by loss of cartilage in control the symptoms of arthritis is torn and how badly they are torn. the joint. Like arthritis at other joints to modify your activities so as not to in the body, it is characterized by pain Grade I Injury — the least damage is aggravate the condition. Application and swelling, especially with activity. of ice to the joint helps decrease pain done, and the AC joint still lines up. Over time, the joint can wear out, lead - and inflammation. Medication including ing to swelling and formation of spurs Grade II Injury — damage to the liga - aspirin, acetaminophen, and non- around the joint. These spurs are a ments which reinforce the AC joint. steroidal drugs anti-inflammatory drugs In a grade II injury these ligaments (NSAIDs) are also used commonly. are only stretched but not entirely torn. When stressed, the AC joint WHAT CAN BE DONE IF becomes painful and unstable. THOSE TREATMENTS DO Grade III Injury — AC and secondary NOT WORK? ligaments are completely torn and If rest, ice, medication and modifying the collarbone is no longer tethered your activity does not work, then the to the shoulder blade, resulting in a next step is a cortisone shot. One shot visible deformity. into the joint sometimes takes care of the pain and swelling permanently, WHAT IS THE TREATMENT although the effect is unpredictable FOR AC SEPARATION? and may be only transient. Surgery may be indicated if nonsurgical meas - These can be very painful injuries, ures fail. Since the pain is due to the so the initial treatment is to decrease ends of the bones making contact with pain. This is best accomplished by each other, the treatment is removal of immobilizing the arm in a sling, and a portion of the end of the clavicle. This placing an ice pack to the shoulder outpatient surgery can be performed for 20 to 30 minutes every two hours through a small incision about one inch as needed.

AC JOINT INJURIES Acetaminophen and non-steroidal anti- Sports Tips are brought to you by the American inflammatory drugs can also help the Orthopaedic Society for Sports Medicine. They provide general information only and are not pain. As the pain starts to subside, it is a substitute for your own good judgement or important to begin moving the fingers, consultation with a physician. To order multiple wrist, and elbow, and eventually the copies of this fact sheet or learn more about shoulder in order to prevent a stiff or other orthopaedic sports medicine topics, please visit www.sportsmed.org. “frozen” shoulder. Instruction on when and how much to move the shoulder should be provided by your physician, physical therapist, or certified athletic trainer. The length of time needed to regain full motion and function depends Copyright © 2008. American Orthopaedic Society for Sports Medicine. All rights reserved. on the severity or grade of the injury. Multiple copy reproduction prohibited. Recovery from a Grade I AC separation usually takes 10 to 14 days, whereas a Grade III may take six to eight weeks.

WHEN IS SURGERY INDICATED? Grade I and II separations very rarely require surgery. Even Grade III injuries usually allow return to full activity with few restrictions. In some cases a painful lump may persist, necessitating partial clavicle excision in selected individuals such as high caliber throwing athletes. Surgery can be very successful in these cases, but as always, the benefits must be weighed against the potential risks.

Expert Consultant: Edward McFarland, MD