AC Joint Injuries

1. Traumatic Impact: AC joint separations often occur due to a fall onto the shoulder or a direct blow to the shoulder region, causing the acromion to move downward relative to the clavicle and disrupting the ligaments that stabilize the joint.
2. Sports Injuries: Participation in contact sports, such as football, rugby, or hockey, increases the risk of AC joint separations due to the potential for high-impact collisions or falls.
3. Motor Vehicle Accidents: Traumatic events, such as motor vehicle accidents, can also result in AC joint separations, particularly if the shoulder experiences significant force or compression.

1. Pain: Patients with AC joint separations typically experience acute or localized pain in the shoulder region, particularly over the AC joint itself.
2. Swelling: Swelling, tenderness, and bruising may develop around the AC joint, indicating soft tissue damage and inflammation associated with the injury.
3. Deformity: A visible deformity or prominence may be observed at the top of the shoulder, often described as a “bump” or “step-off” deformity, where the acromion appears to be displaced relative to the clavicle.
4. Limited Range of Motion: Decreased shoulder range of motion, particularly with overhead activities or movements that involve crossing the arm across the body, may be observed due to pain and instability.

Diagnosing AC joint separations typically involves a combination of clinical evaluation and imaging studies, including:

• Physical Examination: Assessment of shoulder range of motion, stability, and provocative tests to reproduce symptoms, such as the cross-body adduction test or O’Brien’s test.
• X-rays: Plain X-rays of the shoulder may be ordered to assess for bony abnormalities, such as a visible step-off deformity or widening of the AC joint space.
• MRI or CT Scan: Advanced imaging studies, such as MRI or CT scans, may be used to evaluate soft tissue structures, assess the extent of ligamentous injury, and identify any associated fractures or other injuries.

Conservative Management:

• Non-operative treatment is often recommended for low-grade AC joint separations (types I and II) or patients with minimal functional impairment.
• Rest, ice, compression, and elevation (RICE) may help alleviate pain and swelling in the acute phase of the injury, followed by a period of immobilization with a sling or shoulder brace.
• Physical therapy focusing on range of motion exercises, strengthening, and proprioceptive training can help restore shoulder function and stability over time.

Surgical Intervention:

• Indications: Surgical intervention may be considered for high-grade AC joint separations (types III, IV, V, and VI) or patients with persistent pain, instability, or functional impairment despite conservative treatment.
• Procedure: Surgical techniques for AC joint reconstruction may involve direct repair of the torn ligaments, reconstruction using tendon grafts or synthetic materials, or stabilization with hardware such as screws, suture anchors, or plates.
• Rehabilitation: Postoperative rehabilitation typically involves a period of immobilization followed by a progressive rehabilitation program focused on restoring shoulder range of motion, strength, and functional activities.

Recovery from AC joint separations depends on various factors, including the severity of the injury, chosen treatment approach, and individual patient factors. Physical therapy plays a crucial role in postoperative rehabilitation, focusing on restoring shoulder range of motion, strength, and stability while protecting healing tissues and minimizing the risk of complications. Rehabilitation protocols are tailored to the specific injury pattern and patient needs, with a gradual progression of exercises aimed at achieving a safe return to activities and optimizing long-term outcomes.