Acromioclavicular Sprain

by Garreth Myers

The acromioclavicular joint is the joint that connects the collar bone to the shoulder. This joint helps the 360 degree movement of the arm. It allows you to raise your arm above the shoulder along with arm rotation. The two parts of this joint are the acromion and clavicle. These are held together by three important ligaments -- acromioclavicular ligament, coracoaromial ligament and coracoclavicular ligament. These three ligaments hold the joint in place and help it to function properly.

The acromioclavicular sprain is also called a shoulder AC separation. The acromioclavicular ligament sprain or even a slight strain is perhaps the most painful and usually happens when direct force is applied to the joint. The joint tends to be quite prone to injury especially in sport persons who participate in contact sports or bicycling. Not only the joint but even the ligaments tend to get easily injured. Of these three ligaments, the acromioclavicular ligament is most prone to injury. When this joint separates, usually the ligaments also get damaged. Sometimes the ligaments tear or sprain, straining the joint even more.

There is history to the discovery of this injury. Hippocrates identified it in 400 BC. He cautioned against this injury being mistaken for shoulder dislocation. If you play rugby or football or if practice martial arts, you stand a bigger risk of injuring your acromioclavicular joint. Men tend to suffer from this injury much more than women. This injury also occurs more in the twenties and thirties.

Symptoms: The symptoms of this injury can be very painful.

  • Shoulder Pain: The degree of which can vary depending on the intensity of the injury
  • Bruising
  • Swelling
  • Tenderness
  • Stiffness
  • Arm pain
  • Inability to move or deformity depending on the severity of the injury
There are different degrees of injury with this acromioclavicular joint.

  • Grade 1: This is the degree when the acromioclavicular ligament gets sprained. The joint becomes tender and swollen but the joint does not get deformed. X-rays are not needed for this type of an injury.
  • Grade 2: This degree of injury occurs when the acromioclavicular ligament completely tears away from the joint or the coracoaromial ligament partially tears. In this injury, the joint does get deformed and the pain can be extremely intense.
  • Grade 3: Both the ligaments are severed from the joint in this degree of injury. Severe pain and increased disability are important markers of this type of injury. There is considerable deformity too in this injury. X-rays are often required to determine the injury.
Treatment: Treatment for this type of injury has always been under considerable debate. This is the most commonly recommended treatment methods for an Acromioclavicular Sprain, based on the degree of the injury.

  • Grade 1: Ice packs are the best remedy along with moderate pain killers. A sling might be occasionally needed to ensure adequate support and rest.
  • Grade 2: Surgery might not always be needed but anti-inflammatory medication with a sling would work. Recovery takes about 3-6 weeks.
  • Grade 3: Severe AC separations require surgery to repair the torn ligaments. Sometimes the clavicle is held together in place for some time with a special sling before addressing the sprains in the ligament. Tape is also used to keep the collar bone in place. Ultrasound or electrotherapy might also be used to repair the damage.
Physiotherapy is also an important part of the treatment. There are also a grade 4, 5 and 6 in these injuries with increasing severity and surgery is always used to treat the more severe injuries.

Usually once an athlete suffers from this kind of injury; his acromioclavicular joint becomes prone to future injuries. Recovery and follow up care is very important as this particular type of injury does not always heal correctly.

References:
  1. http://www.udel.edu/PT/PT%20Clinical%20Services/journalclub/sojc/10-11/Cote%20et%20al%20rehab%20AC.pdf
  2. http://health.usf.edu/nocms/medicine/orthopaedic/smart/pdfs/patient%20education/shoulder/acromioclavicular%20(AC)%20joint%20sprains.pdf

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