What is the treatment for an Acromioclavicular (AC) joint sprain?

Treatment of Acromioclavicular (AC) Joint Sprains

For AC joint sprains, functional treatment with early mobilization is strongly recommended over immobilization, with the use of a brace or semirigid support providing the best outcomes for pain reduction and return to function. 1

Classification and Initial Assessment

AC joint sprains are typically classified into grades:

• Grade I: Mild sprain with intact ligaments
• Grade II: Partial ligament tear with mild displacement
• Grade III: Complete ligament tear with displacement
• Grades IV-VI: Severe dislocations (typically require surgical management)

Key Assessment Points:

• Mechanism of injury (typically fall on the corner of the shoulder)
• Pain location (point tenderness over AC joint)
• Visible deformity or step-off at the AC joint
• Range of motion limitations
• Pain with cross-body adduction

Treatment Approach Based on Grade

Grade I-III AC Joint Sprains

1. Acute Phase (0-7 days):

   • Pain and swelling management:

     • NSAIDs are recommended to reduce pain and swelling 1
     • Note: Traditional RICE (Rest, Ice, Compression, Elevation) protocol is no longer recommended based on current evidence 1
     • Cryotherapy may be used for symptomatic relief 2

   • Support:

     • Functional support with a brace is preferred over immobilization 1
     • Rigid taping may provide additional stability and pain relief 2
     • Sling use should be limited to the first few days for comfort only

2. Early Rehabilitation Phase (1-3 weeks):

   • Exercise therapy should be started as soon as possible to recover joint functionality 1
   • Begin with:
     • Gentle range of motion exercises
     • Pendulum exercises
     • Isometric strengthening
   • Manual joint mobilization techniques in combination with exercise therapy enhance treatment effectiveness 1

3. Advanced Rehabilitation Phase (3-6 weeks):

   • Progressive strengthening exercises focusing on:
     • Rotator cuff muscles
     • Scapular stabilizers
     • Core strengthening
   • Proprioceptive training
   • Sport-specific exercises for athletes

Grade IV-VI AC Joint Sprains

• Surgical management is typically recommended 3

Recovery Timeline and Expectations

Patients should be advised that recovery from AC joint sprains can be prolonged:

• 40% of patients may still experience significant pain at 6 months post-injury
• 14% may have persistent pain beyond 12 months 4
• Patients symptomatic at 6 months are more likely to have persistent symptoms beyond 1 year 4

Return to Activity Guidelines

1. Work resumption:

   • Immediate functional treatment and a structured return-to-work schedule are advised to minimize work absenteeism 1

2. Sports resumption:

   • Supervised exercises focusing on proprioception, strength, coordination, and function are recommended 1
   • Overhead activities (climbing, strength training, overhead ball sports) may be particularly affected 5
   • Return criteria:
     • Pain-free range of motion
     • Restored strength (compared to uninjured side)
     • Functional stability during sport-specific movements

Special Considerations

• Athletes involved in overhead activities may experience more prolonged recovery 5
• Some patients (6-9%) may need to modify their sporting activities long-term 4
• Multimodal approaches including conventional physical therapy with movement with mobilization techniques show promising results for functional recovery 2

Common Pitfalls to Avoid

1. Prolonged immobilization - This can lead to stiffness and delayed recovery
2. Returning to activities too soon - May lead to chronic pain or instability
3. Neglecting scapular stabilization - Essential for proper shoulder function
4. Overlooking persistent symptoms - Patients with symptoms beyond 6 months may need additional intervention

By following this evidence-based approach to AC joint sprain management, patients can achieve optimal functional outcomes while minimizing the risk of chronic pain and disability.