AC Joint Separation Treatment Options
Often referred to as a shoulder separation, an acromioclavicular (AC) joint separation is commonly caused by a fall or direct blow to the top of the shoulder. This injury to the ligaments that surround and stabilize the AC joint can cause a dislocation of the clavicle from part of the shoulder blade (the acromion).
An AC joint separation can range from a mild sprain to a severe shoulder separation. There are six grades of AC joint separation which are classified by the severity of the injury and the ligaments are torn.
Most people with a grade one to three separation are able to return to normal function with non-operative treatment. Even professional athletes are able to return to their sports without having to undergo surgery. It is often recommended to wait and see if the AC joint heals on its own. Some people may have ongoing pain. Persistent pain may be caused by:
- Abnormal biomechanics when the joint is in motion
- Development of arthritis
- Injury to the fibrocartilage between the clavicle and acromion, which normally reduces friction and prevents the two bones from rubbing together.
Since an AC joint separation can be painful, especially in more severe separations, the initial treatment is to decrease the pain. The pain usually subsides after two to four weeks.
Early treatment includes:
- Immobilizing the arm in a sling
- Ice (for 20-30 minutes every two hours) to reduce pain and swelling
- Pain and anti-inflammatory medications
- Physical therapy to restore normal motion, strength, and shoulder biomechanics
As symptoms begin to resolve, a physical therapy program can help the patient to prevent “frozen shoulder” (a severe loss of shoulder movement due to inflammation), restore range of motion, strengthen the shoulder, and restore normal shoulder biomechanics.
Athletes who wish to return to sports could expect to need anywhere between two to twelve weeks of rest time, depending on the grade of the injury. An athlete is allowed to return to sports once they have a full range of motion with no pain, no more tenderness at the AC joint, and manipulation of the shoulder does not cause pain.
Most AC joint separations are treated successfully with conservative methods. Recent studies have shown that in most instances of an AC joint injury, non-operative treatment may be better than surgery. Within two to three months, most patients heal without surgical intervention.
The vast majority of patients presenting with an AC joint separation do not require surgery. However, with a more severe AC separation classified as a type 4, 5, or 6, surgery is usually recommended. Dr. Harrison has developed a surgery technique for the treatment of severe type 4 and type 5 separations with excellent results. Surgery is especially necessary if the patient falls into one of the following categories:
- Young, active patients that are over the age of 13
- Hard laborers whose overhead movements place heavy demands on the shoulders
- Athletes whose overhead movements are stressful and frequent, such as a high-caliber baseball pitcher
Surgery may also be indicated if the deformity of the AC joint is severe, or there is persistent pain due to the collarbone due to the ends of the bones making contact with each other. In order to eliminate pain, a surgeon might recommend removing a small part of the collarbone so it does not rub against the acromion. The AC joint is one of the few joints in the body that can withstand removing a portion of the end of the collarbone.
There are several other techniques, including reconstruction of the ligaments that attach to the underside of the collarbone, and all have the same recovery and results. Most patients are able to return home the same day as the surgery, and wear an arm sling until the stitches are removed a week later.
Improved movement of the shoulder can be seen right away, although it takes four to six weeks to regain full range of movement and even longer to regain strength. Most patients experience pain relief after surgical treatment, and up to 95% of patients who have surgery are able to return to the same level of activity and sports as prior to the injury.
Dr. Harrison is a board-certified fellowship trained orthopedic and sports medicine surgeon who specializes in arthroscopic knee and shoulder surgery. He is the Head Team Physician for the United States Alpine Ski Team and the Head Team Physician for Weber State University for over 20 years. Dr. Harrison completed his undergraduate degree at Baylor University and received his medical degree from the University of Arizona College of Medicine. He completed his orthopedic residency at the University of Utah followed by a fellowship in sports medicine at the Cincinnati Sports Medicine and Orthopedic Center. He finished his formal training with an additional AO Trauma Fellowship in Bern, Switzerland.
At a Glance
Dr. Jeffrey Harrison
- Board-Certified, Fellowship-Trained Orthopedic Surgeon
- Head Team Physician US Women's Alpine Team and Weber State University
- Performs over 800 surgeries per year
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