What is the management for a grade 1 Acromioclavicular (AC) joint strain with mild widening after a fall?

Management of Grade 1 AC Joint Strain with Mild Widening

Conservative management with functional support and early exercise therapy is the preferred treatment for grade 1 AC joint strain with mild widening after a fall. 1

Initial Management

• Apply functional support (brace or tape) for 4-6 weeks to provide stability while allowing controlled loading of damaged tissues 2, 1
• An AC joint brace is often easier to apply and maintain than taping, especially for maintaining proper joint alignment 1
• Limit immobilization to a maximum of 10 days if needed for pain control, after which functional treatment should be commenced 2, 1
• Use NSAIDs or acetaminophen at the lowest effective dose for pain management during the acute phase 3, 1

Exercise Therapy

• Begin exercise therapy as early as possible to recover joint functionality and prevent stiffness 2, 1
• Focus initial exercises on:
  • Range of motion exercises to maintain mobility 3, 1
  • Proprioception training to improve joint stability 1
  • Gradual strengthening of rotator cuff and posterior shoulder girdle muscles 3, 1
• Progress to coordination and functional movement exercises as pain allows 1

Activity Modification

• Modify daily activities to reduce stress on the AC joint during the healing process 3, 4
• Avoid activities that cause pain, particularly those involving overhead movements or direct pressure on the joint 4
• Gradually return to normal activities based on:
  • Resolution of pain and swelling 1
  • Recovery of range of motion 1
  • Restoration of strength 1

Follow-up and Progression

• Regular follow-up is essential to monitor healing and adjust treatment as needed 1
• Be aware that symptoms may persist beyond 6 months in some patients (14-40% report ongoing pain at 6 months) 5
• There is a positive correlation between patients symptomatic at 6 months and those whose symptoms persist beyond 1 year 5

When to Consider Additional Interventions

• If pain persists despite adequate conservative management, consider:
  • Manual joint mobilization combined with exercise therapy 2, 1
  • Advanced imaging (MRI) to evaluate for associated injuries 2, 1
• Surgical intervention is rarely indicated for grade 1 AC joint injuries and should be reserved only for cases that do not respond to comprehensive functional treatment 1, 6

Common Pitfalls to Avoid

• Prolonged immobilization can lead to joint stiffness, muscle atrophy, and delayed recovery 2, 1
• Returning to full activities too soon may result in re-injury or chronic instability 1
• Underestimating the potential for long-term symptoms - up to 52% of patients with grade 1-2 AC joint injuries may have persistent symptoms 7
• Failing to obtain proper radiographic views (AP views in internal and external rotation and an axillary or scapula-Y view) when evaluating shoulder pain 2

Prognosis

• Most patients with grade 1 AC joint injuries recover well with conservative management 4, 6
• However, patients should be advised that symptoms may persist beyond the expected healing time in some cases 7, 5
• Radiographic changes (degenerative changes, ossification of coracoclavicular ligaments, distal clavicular osteolysis) may develop in the long term even with appropriate treatment 7