What is the treatment for a minor Acromioclavicular (AC) joint separation?

Treatment for Minor AC Joint Separation

For minor acromioclavicular (AC) joint separations (Grade I-II), conservative non-operative management is the recommended treatment approach, focusing on pain control, progressive rehabilitation exercises, and gradual return to activities. 1, 2

Initial Management

• Pain Control and Rest:

  • NSAIDs as first-line medication for pain management (taper as tolerated) 1
  • Local cold therapy for pain relief 1
  • Relative rest and activity modification to avoid painful movements
  • Sling or shoulder immobilizer for comfort during the acute phase (typically 1-2 weeks) 2

• Early Rehabilitation (Phase 1: 0-2 weeks):

  • Focus on pain control measures
  • Gentle range of motion exercises within pain-free limits
  • Proper positioning education
  • Isometric exercises for muscle reactivation if no pain is present 1

Progressive Rehabilitation

• Phase 2 (2-6 weeks):

  • Progressive ROM exercises
  • Light strengthening exercises for rotator cuff and periscapular muscles
  • Scapular stabilization exercises 1
  • Gradual weaning from sling/immobilizer

• Phase 3 (6+ weeks):

  • Progressive resistance training
  • Advanced scapular stabilization
  • Sport or activity-specific training 1
  • Focus on rotator cuff and periscapular muscle strengthening 2

Follow-up and Monitoring

• Initial follow-up at 1-2 weeks after treatment initiation to assess response 1
• Clinical reassessment at 6 weeks to evaluate progress 1
• Rehabilitation progress evaluation at 3 months 1

Important Considerations

1. Return to Activities:

   • Return to work and sports is significantly faster with non-operative treatment compared to surgical intervention 3
   • Patients with Grade I-II injuries can typically return to normal activities when pain-free and full strength/range of motion is restored

2. Complications and Outcomes:

   • Non-operative treatment for minor AC separations has shown excellent functional outcomes 3, 2
   • No complications have been reported in non-operatively treated patients with minor AC separations 3
   • Research shows no significant strength deficits in Grade II injuries treated non-operatively, though some weakness in horizontal abduction at fast velocity may occur 4

3. When to Consider Further Intervention:

   • If symptoms worsen or do not improve by 3 months, consider imaging or surgical consultation 1
   • Persistent pain (VAS>7) after 7 days with no functional improvement may warrant further evaluation 3

Pitfalls to Avoid

• Returning to sports or heavy activities too quickly before adequate healing and rehabilitation
• Neglecting scapular stabilization exercises, which are crucial for proper shoulder function
• Overreliance on immobilization, which can lead to stiffness and prolonged recovery
• Excessive use of corticosteroid injections (should be limited to avoid potential tendon weakening) 1
• Failure to recognize when a seemingly minor AC separation might actually be a higher-grade injury requiring different management

Remember that while Grade I-II AC separations are generally treated conservatively with excellent outcomes, Grade III injuries have more controversy regarding optimal treatment, and Grades IV-VI typically require surgical intervention 5, 2.