Physical therapy guide to acromioclavicular joint ac joint. Walking or exercise bike in sling le resistance exercises if able to protect surgical area. This injury commonly occurs from a direct blow to the shoulder such as a fall during sporting activity. Ac joint sprain shoulder separation ac injury physioadvisor. Acute acromioclavicular ac joint separation iiii protocol, 2010. There is truly no right or wrong answer because this is a very hotly controversial area of modern day orthopedic treatment. Wojcik, mspt, atcb, gregg gomlinski, mspt, cscsb, augustus d. Examination and presentation of acromioclavicular joint injuries. An ac joint sprain or separation is often the result of falling with an outstretched arm. The joint is held together by several ligaments the acromioclavicular ligament and the coracoclavicular ligaments which provide stability to the joint. 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. Type i with only a sprain of the ac joint ligaments, no joint deformity is apparent during physical or radiographic examination. The closed pack position for the ac joint is 90 degrees of shoulder abduction.
Guidelines for rehab are determined through an understanding of anatomy, pathoanatomy and biologic healing. 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. The rice protocol is the goto treatment for any ligament injury. 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. Ac joint pain exercises for shoulder rehab youtube. A careful and precise xray evaluation is critical in diagnosing the correct ac joint separation grade. Ir behind the back, crossbody adduction, and endrange flexion are to be approached cautiously and within the patients own pain threshold. There is, however, a lack of evidence regarding rehabilitation protocols. A shoulder separation is a fairly common injury, especially in certain sports. Type iii injuries typically have full rom at 23 weeks with gentle rom exercises and.
The ac joint is where the collarbone clavicle meets the highest point of the shoulder blade acromion. Ac sprain university of miami sports medicine institute. Physical therapy protocols boston shoulder institute. 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. Rehab shoulder ac joint reconstruction and protocol. Conservative and operative rehabilitation from the physical therapy library of. We provide our patients with comprehensive, coordinated care from experts who understand the unique needs of women in sports. Acromioclavicular ac dislocation repair rehab protocol. Mazzocca, ms, mda, acromioclavicular joint ac separations are one of the most common injuries seen in. 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.
Grade 3 ac separation grade 3 ac joint separation steven. Jun 06, 2016 an ac joint sprain or separation is often the result of falling with an outstretched arm. 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. Contact sports such as football, wrestling and rugby commonly see ac joint. Rehabilitation of acromioclavicular joint separations. Shoulder separation and acromioclavicular joint injury dr. 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.
An ac sprain, also called separated shoulder, occurs when the acromioclavicular ac joint connects your collarbone to your shoulder is injured. Gradually progress sport activities to unrestrictive participation continue stretching and strengthening program note well. Acromioclavicular sprain rehabilitation program angelfire. 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. Ac joint sprain exercises sports injury rehabilitation. Postsurgical rehabilitation following acromioclavicular joint. Continue deltoid and rotator cuff isometric exercises in multiple planes. Phase1focusesontheelim ination of pain and protection of the ac joint through sling immobilization 310 days, along with the prevention of muscular atrophy. 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. Interferential stim can be used with ice at the same time 3 nsaids a. Determining what to do with each ac joint sprain is relatively easy once you have determined its severity. Type iii ac separations pose a controversial course of therapeutic management. The sports physical therapy service is an integral part of the sports medicine center and the department of physical and occupational therapy.
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. Sports medicine physical therapy rehabilitation protocols. Keeping your chin level, turn your head to the right, and hold for 15 to 30 seconds. Adults in their 20s suffer most ac joint injuries 43%. Core therapeutic exercises if able to protect surgical area. Ac joint separation recovery time steven struhl md new.
Progress prone posterior shoulder girdle exercises. 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. Acromioclavicular ac joint reconstruction rehab protocol. The shoulder blade gives rise to a bony prominence known as the 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. This treatment is usually done within the first 72 hours of injury. The ac joint is the connection between the scapula shoulder blade and the clavicle collarbone. Ac joint separation recovery time and the return to active sports vary. Ac joint sprains are often caused by a fall onto an outstretched arm. 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. Stand upright and hold a stick in both hands, palms down.
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. Apply ice or cold therapy and compression wrap as soon as possible to reduce pain and swelling. This will normally be 714 days for grades 1 and 2 sprains. Most shoulder separations are actually injuries to the acromioclavicular ac joint. The ac joint is a plane synovial joint comprised of the acromial process of the scapula and the lateral end of the clavicle. Acromioclavicular separation brigham and womens hospital. These exercises are intended to help maintain joint mobility and. Postsurgical rehabilitation following acromioclavicular joint reconstruction ramin r. 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. The postoperative rehabilitation protocol for sternoclavicular joint reconstruction employed at the senior authors institution emphasizes avoidance of scapular protraction and retraction appendix 1. Wear a sling to immobilize the shoulder and ease pain by taking the weight of the arm.
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. Postoperative shoulder ac joint reconstruction rehabilitation protocol from san francisco orthopaedic sports medicine surgeon dr. Shoulder dislocations and ac joint separations are often mistaken for each other. Acromioclavicular ac joint injury is a term used to describe an injury to the. Ac joint separationsprain virtual sports injury clinic.
Use ice for 15 minutes per application to control pain and swelling. Diagnosis and management of grade ii acromioclavicular joint. The acromioclavicular joint, also known as the ac joint, is that bony bump you notice and feel on top of your shoulder. Diagnosis and management of grade ii acromioclavicular joint separation anna kiner 236 the circle, queen elisabeth street, london se1 2jn, uk. It can be due to trauma, such as joint dislocation of the acromioclavicular joint or degenerative conditions, such as osteoarthritis. Mobility exercises can begin only once shoulder movement is painfree. Shoulder separation exercises summit medical group.
The joint joins your collarbone to your shoulder blade. The sports physical therapy service is an integral part of the sports medicine center and the department of. Of the injuries to the shoulder girdle, 9% involve the ac joint. A mild shoulder separation involves a sprain of the ac ligament that does not move the collarbone and looks normal on xrays. Mechanism of injury the most common cause for a separation of the ac joint is from a fall directly onto the shoulder. 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. Diagnosis and management of grade ii acromioclavicular. 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.
A more serious injury tears the ac ligament and sprains or slightly tears the coracoclavicular cc ligament, putting the collarbone out. Postsurgical rehabilitation following acromioclavicular. A mild shoulder separation involves a sprain of the ac ligament that does not move. The acromioclavicular joint or the ac joint is a diarthrodial joint with an interposed fibrocartilaginous meniscal disc connecting the clavicle with the acromion. Conservative management of a type iii acromioclavicular. 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. The signs and symptoms are local tenderness over the ac joint. In a shoulder separation also known as an acromioclavicular ac joint separation, the joint of the clavicle and the scapula is disrupted. Conservative management of a type iii acromioclavicular separation. Immediate first aid for any ac joint injury is to apply the price principles of rest, ice, compression and elevation. Nov 08, 2016 rehabilitation of ac joint separation injuries. Commonly, injury happens when falling onto an outstretched hand or elbow, direct blows to the shoulder, or falling onto the point of the shoulder. With this condition, there iusually pain that limits the motion ofthe arm. The fall injures the ligaments that surround and stabilize the ac joint.
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. 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. 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. 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. Ac joint arthrosis, or osteoarthritis of the, acromioclavicular joint is most common in people who are middle aged. Minimal tenderness and swelling may be present over the ac joint. 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. Movement of the joint will help increase the healing and. A fibrous capsule surrounds the joint and there may be a. Pain associated with an ac injury may be difficult to localize because of the complex sensory innervations of the joint. 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. Find pdfs of our most common rehabilitation protocols. Here we explain the symptoms, causes, and treatment for ac joint sprains.
There are approximately 50,000 ac joint separations that occur each year in the us and most of them will be treated nonsurgically initially. Rehabilitation of acromioclavicular joint injuries. My repair technique preserves the end of the clavicle and rebuilds the key ligaments that are torn with new donor tissue. Frisbie memorial hospital gr iii acromioclavicular separation. 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 patient received acupuncture, joint mobilizations, palliative adhesive taping of the ac joint, active release technique, and progressive resisted exercises. The ac joint is a resilient joint that can resist significant amounts of force before disruption. Sprains are the most common injury occurring at the ac joint, typically in. Ac joint pain either from arthritis or osteolysis can be treated in many ways.
An acromioclavicular joint separation, or ac separation, is a very frequent injury among physically active people. It develops when the cartilage in the ac joint begins to wear out. Shoulder separation and acromioclavicular joint injury. Turn your head to the left, and hold for 15 to 30 seconds. Initially complete rest, immobilization and regular application of ice or cold therapy is important to reduce pain and inflammation. A grade i separation involves a sprain of the ac ligaments without clavicle. Stretch your arms by lifting them over your head, keeping your arms straight. Acromioclavicular joint injury shoulder separation beyond the basics, 20. You may know a sprained ac joint by its more common name a shoulder separation.
Variances will be communicated by the surgeon directly to rehabilitation services. 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. Sports medicine physical therapy 6176439999 we use cookies and other tools to enhance your experience on our website and to analyze our web traffic. An injury or sprain occurs when these ligaments become strained, overstretched or torn completely. Gladstone and colleagues28 described a 4part physical therapy protocol for the treatmentofgradei,ii,andiiiacjointinjuriesinathletes. An ac joint sprain or ac joint separation is when the acromioclavicular joint separates. Control inflammation and pain reduce swelling rehab. Ibuprofenadvil 4 times a day for 3 days only if no allergies phase ii restore range of motion 24 days for grade i.
Another way to people sprain an ac joint is to run directly into something, such as a tree while skiing, with great force. Rehabilitation is an important part of the management of any grade separation of the ac joint. An ac joint injury will either be a minor injury grade 1 or grade 2, or a major injury grade. Movement of the joint will help increase the healing and decrease scarring. 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. Physical therapy management of the patient with an acromioclavicular joint.
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