From the Guidelines
Acromioclavicular joint separation should be treated conservatively for mild to moderate separations (grades I-III), while severe separations (grades IV-VI) may require surgical intervention. The treatment approach depends on the severity of the separation, which is graded from I to VI. For mild to moderate separations, conservative treatment is recommended, including rest, ice application, a sling for comfort, and over-the-counter pain medications such as ibuprofen or acetaminophen as needed 1.
Conservative Treatment
- Rest and ice application for 20 minutes every 2-3 hours for the first 48-72 hours
- A sling for comfort for 1-2 weeks
- Over-the-counter pain medications such as ibuprofen (400-600mg three times daily) or acetaminophen (500-1000mg every 6 hours) as needed
- Physical therapy should begin after the acute pain subsides, typically within 1-2 weeks, focusing on range of motion exercises and gradually progressing to strengthening
Surgical Intervention
For severe separations (grades IV-VI), surgical intervention may be necessary to restore joint alignment and function, as unstable or significantly displaced fractures often require acute surgical management 1. The recovery time varies from 2-6 weeks for mild separations to 3-4 months for severe cases requiring surgery. The injury occurs due to direct trauma to the shoulder, often from falling onto an outstretched hand or direct impact to the shoulder, causing the acromion to be forced downward while the clavicle maintains its position, resulting in ligament damage and joint displacement.
Important Considerations
- The incidence of traumatic shoulder injuries is difficult to determine because some injury types, such as low-grade acromioclavicular separations and acute rotator cuff tears, are likely underreported because patients do not seek immediate medical treatment 1
- Traumatic shoulder pain tends to disproportionately involve young adults and male patients 1
From the Research
Acromio Clavicular Joint Separation
- Acromioclavicular joint separation is a common injury that can be caused by various factors, including trauma and osteoarthritis 2.
- The treatment of acromioclavicular joint separation can be controversial, especially for type III separations 2.
- Surgical techniques for managing acromioclavicular joint separations can be categorized into several basic techniques, including soft-tissue repair, trans-articular AC joint fixation, and coracoclavicular fixation 3.
Treatment Options
- Non-operative treatment options for acromioclavicular joint pain include non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids 4.
- Surgical treatment options for acromioclavicular joint osteoarthritis include distal clavicle excision, which can be performed using various surgical approaches 4.
- The choice of surgical treatment option depends on factors such as avoidance of AC ligament damage, clavicular instability, and post-operative pain 4.
Challenges in Treatment
- There is limited evidence to support one intervention or treatment over another for acromioclavicular joint pain, making it difficult to develop evidence-based patient pathways of care 5.
- High-level studies on treatment modalities for acromioclavicular joint pain are limited, and no direct studies have compared the benefits or risks of conservative versus surgical management in a controlled environment 5.