From the Guidelines
Acromioclavicular (AC) joint separation in children is best managed conservatively in most cases. The American Academy of Orthopaedic Surgeons clinical practice guideline summary on the treatment of clavicle fractures 1 provides evidence-based recommendations that can be applied to the management of AC joint separations in children. Initial treatment includes:
- Rest
- Ice application for 15-20 minutes every 2-3 hours
- A sling for comfort (typically for 1-3 weeks depending on severity)
- Appropriate pain management with acetaminophen (15 mg/kg/dose every 4-6 hours, maximum 75 mg/kg/day) or ibuprofen (10 mg/kg/dose every 6-8 hours with food)
For mild to moderate separations (Type I-II), children typically recover well with conservative management and can gradually return to activities as symptoms improve, usually within 2-6 weeks. Physical therapy focusing on range of motion and strengthening exercises should begin after the acute pain subsides, typically at 1-2 weeks post-injury. Severe separations (Type IV-VI) may require surgical consultation, though this is less common in children than adults due to children's greater healing capacity and the presence of growth plates, as noted in the AAOS guideline 1. The excellent blood supply and healing potential in children's developing bones contribute to their favorable outcomes with non-operative management. Parents should be advised that complete healing typically takes 6-12 weeks, and return to contact sports should be delayed until full strength and range of motion are restored, usually around 6-12 weeks depending on severity.
From the Research
Acromio Clavicular Joint Separation in Children
- Acromioclavicular joint separations are common injuries of the shoulder girdle, especially in the young and active population 2.
- The mechanism of this injury is typically a direct force against the lateral aspect of the adducted shoulder, with the magnitude of the force affecting injury severity 2.
- In children, acromioclavicular joint separations can be managed conservatively, especially in those below the age of 13, with good or excellent results expected 3.
- Children below the age of 13 rarely sustain a complete acromioclavicular joint dislocation, but usually sustain a fracture of the distal clavicle with an intact acromioclavicular joint 3.
- Conservative management of grade I-III acromioclavicular joint separations is still the main recommendation, with a best practice guideline developed to help guide clinicians 4.
Treatment Approaches
- Low-grade injuries are frequently managed successfully using non-surgical measures, while high-grade injuries frequently warrant surgical intervention to minimize pain and maximize shoulder function 2.
- Various operative and nonoperative treatment schemes have been described for the management of acromioclavicular joint injuries, with controversy surrounding the efficacy of surgical reconstruction versus nonoperative intervention for grade III type injuries 5.
- Surgical techniques have been introduced to manage symptomatic, high-grade injuries, with the importance of the acromioclavicular capsule and ligaments recently emphasized 6.
Age-Related Considerations
- Children of 13 years and older usually sustain complete dislocations of the acromioclavicular joint similar to adults, and are treated accordingly 3.
- Patients above age 13 with adult-type acromioclavicular joint dislocations are treated as adults, with surgical treatment considered for those who do not respond well to conservative management 3, 6.