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

AC Joint Sprain Treatment

For AC joint sprains (grades I and II), conservative treatment with early functional rehabilitation is the definitive approach, avoiding immobilization beyond initial pain control and prioritizing progressive range-of-motion and strengthening exercises.

Initial Management (First 72 Hours)

• Apply the PRICE protocol for the first 72 hours: Protection of the joint, Rest (up to 72 hours only), Ice application to reduce swelling and pain, Compression with bandaging, and Elevation to minimize fluid accumulation 1
• Use NSAIDs for short-term pain relief (less than 14 days) to control pain and swelling without significantly increasing adverse events 2
• Consider a brief period of sling immobilization (less than 10 days) to decrease initial pain and edema, but avoid prolonged immobilization which leads to worse outcomes 2, 1
• Paracetamol (acetaminophen) is equally effective as NSAIDs for pain control if NSAIDs are contraindicated 2

Functional Rehabilitation (After 72 Hours)

• Begin supervised exercises immediately after the initial 72-hour period, focusing on restoring range of motion first, then progressing to strengthening exercises 1
• Prioritize exercises targeting proprioception, strength, coordination, and function as these lead to faster recovery and return to activities 2
• Use functional support devices (semirigid braces or splints) for 4-6 weeks rather than elastic bandages, as semirigid supports are more effective and cost-efficient 2, 1
• Avoid prolonged immobilization beyond 10 days, as this correlates with worse functional outcomes and delayed return to work 2, 3

Expected Recovery Timeline

• 40% of patients report significant pain at 6 months, decreasing to 14% at 12 months or beyond 4
• Patients symptomatic at 6 months are likely to have persistent symptoms beyond 1 year (positive correlation r=0.6), so counsel them accordingly 4
• Re-examine patients at 3-5 days post-injury when pain and swelling have improved to better assess ligament damage severity 1
• Conservative treatment yields excellent functional outcomes with mean Constant scores of 97/100 points, equivalent to surgical treatment 3

Surgery Considerations

• Surgery is NOT recommended for grades I and II AC joint sprains, as conservative treatment produces equivalent or superior functional outcomes with fewer complications 3, 5
• Surgical treatment results in more complications (11 complications in 56 surgically treated patients requiring 5 additional procedures, versus 1 complication in 29 conservatively treated patients) 3
• Surgery leads to more frequent pain complaints, later return to work, and increased degenerative radiographic changes without improving functional scores 3
• Reserve surgery only for grade III injuries in professional athletes requiring rapid return to play, or for chronic symptomatic instability unresponsive to comprehensive conservative treatment 6, 5

Common Pitfalls to Avoid

• Do not underestimate the severity of grade I and II sprains: 27% develop chronic AC joint pathology requiring subsequent surgery, and only 52% remain completely asymptomatic long-term 7
• Avoid NSAIDs beyond 14 days, as they may delay natural healing since inflammation is necessary for tissue recovery 2
• Do not use opioid analgesics routinely, as they cause significantly more side effects than NSAIDs without superior pain relief 2
• Warn patients that 9% may experience limitations in activities of daily living and 6% may need to modify sporting activities despite conservative treatment 4
• Anticipate that degenerative radiographic changes occur in most patients (only 4 of 33 had no radiographic changes at long-term follow-up), but these do not correlate with functional outcomes 7, 3

Prevention of Recurrence

• Continue functional support devices (bracing) during high-risk activities, particularly for patients with history of recurrent sprains 1
• Educate patients on joint protection techniques to avoid adverse mechanical factors during activities 1
• Maintain ongoing strengthening and proprioceptive exercises as part of regular training to prevent recurrent injuries 2