From the Research
For a Grade 3 AC joint separation, nonoperative treatment is the most cost-effective approach, yielding the lowest total cost and greatest utility, and should be the initial treatment of choice, as supported by the most recent study 1.
Treatment Approach
The treatment of Grade 3 AC joint separations typically begins with conservative management, including:
- Rest, ice, pain medication, and a sling for comfort
- Over-the-counter pain relievers like ibuprofen (400-600mg every 6-8 hours) or naproxen (220-440mg twice daily) for pain and inflammation
- Ice application for 15-20 minutes every 2-3 hours during the first few days
- Wearing a sling for 1-2 weeks to support the joint and limit movement while initial healing occurs
Rehabilitation Process
After the acute phase, the rehabilitation process should include:
- Gentle range-of-motion exercises around week 2-3
- Strengthening exercises for the shoulder and rotator cuff muscles starting around week 4-6
- Physical therapy, which is highly recommended to guide this rehabilitation process, typically lasting 6-12 weeks
Indications for Surgery
Surgery is generally reserved for high-level athletes or those with persistent pain after conservative treatment, as noted in 2 and 3.
Expected Outcomes
Most people with Grade 3 separations can return to normal activities within 2-3 months, though a visible bump may remain at the injury site, as mentioned in 4.
Rationale for Nonoperative Treatment
The approach of nonoperative treatment allows the body to form scar tissue around the separated joint while maintaining shoulder function, which is why surgery isn't automatically recommended despite the complete ligament tear in Grade 3 injuries, as supported by the cost-effectiveness analysis in 1 and the updated treatment strategies in 5.