Treatment of Low-Grade AC Joint Injury
Low-grade (Type I and II) acromioclavicular joint injuries should be treated non-operatively with brief sling immobilization for comfort followed by early functional rehabilitation, as this approach consistently produces excellent functional outcomes without the complications associated with surgery. 1, 2, 3
Initial Management
- Apply a sling for comfort only, typically for a short period (days to 1-2 weeks maximum), not for rigid immobilization 2, 3
- Implement the PRICE protocol immediately: Protection, Rest, Ice, Compression, and Elevation to control pain and swelling 4
- Remove the sling as soon as tolerable to prevent stiffness and begin rehabilitation 2
Diagnostic Confirmation
- Obtain plain radiographs as the preferred initial imaging modality, with upright views preferred over supine to accurately assess any malalignment 5
- Include anteroposterior views in internal and external rotation plus an axillary or scapula-Y view to confirm the diagnosis and exclude fracture or higher-grade separation 5
- Advanced imaging (MRI or CT) is not indicated for Grade I-II injuries unless there is concern for concomitant rotator cuff injury or other soft tissue pathology 5
Rehabilitation Protocol
- Begin early range-of-motion exercises as soon as the sling is removed to prevent stiffness 6, 2
- Progress to strengthening exercises once pain allows, emphasizing restoration of full shoulder function 1, 2
- Most patients achieve full return of function with this conservative approach 1
Expected Outcomes and Long-Term Considerations
- Functional outcomes with conservative treatment are excellent, with patients typically achieving 97 of 100 possible points on validated shoulder function scores 6
- Conservative treatment results in fewer complications, less pain, and earlier return to work compared to surgical intervention for low-grade injuries 6
- Some patients may develop degenerative changes at the AC joint over time, but these radiographic findings do not correlate with functional outcomes or symptoms 6
- If chronic pain develops from post-traumatic degenerative changes, consider a corticosteroid injection or, as a last resort, distal clavicle excision 2
Common Pitfalls to Avoid
- Do not pursue surgical treatment for Type I-II injuries, as surgery increases complication rates, delays return to activity, and provides no functional benefit over conservative management 6, 2
- Do not keep patients immobilized in a sling for extended periods, as this leads to stiffness without improving outcomes 2
- Do not assume that overhead athletes or manual laborers require surgery for low-grade injuries—conservative treatment is appropriate regardless of occupation or physical demands 2