What is the treatment protocol for grade 1 and grade 2 Acromioclavicular (AC) joint sprain?

From the Guidelines

The treatment protocol for grade 1 and 2 AC joint sprains primarily involves conservative management, with a focus on rest, ice application, compression, and elevation, as well as pain management with NSAIDs, and early controlled mobilization to prevent stiffness. The initial treatment includes rest, ice application for 15-20 minutes every 2-3 hours for the first 48-72 hours, compression with an elastic bandage, and elevation of the affected arm 1. Pain management typically consists of NSAIDs such as ibuprofen (400-600mg three times daily) or naproxen (500mg twice daily) for 7-10 days. A sling may be used for comfort for 1-2 weeks, but early controlled mobilization is encouraged to prevent stiffness.

Key Components of Treatment

• Rest and limiting the use of the injured extremity to avoid worsening the injury 1
• Cold application to decrease pain and swelling, with the greatest tissue cooling achieved by using a bag filled with ice and water surrounded by a damp cloth 1
• Pain management with NSAIDs, such as naproxen 500 mg BID or meloxicam 7.5–15 mg daily orally for 4–6 weeks 1
• Early controlled mobilization to prevent stiffness and promote healing
• Gradual return to activities over 2-6 weeks for grade 1 sprains and 6-8 weeks for grade 2 sprains

Physical Therapy and Rehabilitation

Physical therapy should begin after the acute phase, focusing on range of motion exercises, followed by strengthening of the rotator cuff, deltoid, and scapular stabilizers. This approach allows the ligaments to heal while maintaining joint mobility and muscle strength, as the AC joint has sufficient stability for daily activities even with partial ligament disruption. Conservative treatment is highly effective for these injuries, with over 90% of patients achieving good functional outcomes without surgery 1.

From the Research

Treatment Protocol for Grade 1 and Grade 2 AC Joint Sprain

• The treatment protocol for grade 1 and grade 2 AC joint sprain is typically nonsurgical 2.
• Conservative measures such as rest, ice, and physical therapy are often recommended 3.
• The goal of treatment is to reduce pain and inflammation, improve range of motion, and strengthen the surrounding muscles.

Conservative Treatment

• A study published in the Journal of Shoulder and Elbow Surgery found that 52% of patients with grade 1 and 2 AC joint sprains remained asymptomatic after conservative treatment 3.
• The study also found that 27% of patients developed chronic AC joint pathology that required subsequent surgery.
• Another study published in The Journal of the American Academy of Orthopaedic Surgeons found that treatment is typically nonsurgical for type I and II injuries 2.

Rehabilitation

• A review of the literature on rehabilitation protocols for AC joint injuries found that few detailed protocols have been published 4.
• The review identified three common barriers preventing successful rehabilitation: pain, apprehension, and stiffness, which can be addressed through goal-oriented rehabilitation protocols 4.
• Rehabilitation protocols should be individualized and allow for critical thinking and effective communication among clinicians and therapists 4.

Medication

• Acetaminophen may be used to manage pain and inflammation in patients with AC joint sprains 5.
• However, the evidence suggests that NSAIDs may be more effective than acetaminophen for improving knee and hip pain in people with osteoarthritis, but have not been shown to be superior in improving function 5.