From the Research
Treatment for an AC joint separation should be based on the severity of the injury, with conservative treatment recommended for grades I-III and surgical intervention considered for grades IV-VI, as evidenced by the most recent study 1. The severity of the AC joint separation is crucial in determining the treatment approach. For mild to moderate separations (grades I-II), conservative treatment is usually effective, including:
- Rest
- Ice application for 20-30 minutes several times daily
- Compression with an elastic bandage
- Elevation of the affected arm Pain management involves over-the-counter medications like ibuprofen (400-600mg three times daily) or naproxen (220-440mg twice daily) for 1-2 weeks. A sling may be recommended for comfort during the first week. Physical therapy should begin after the acute pain subsides, focusing on range-of-motion exercises and gradually progressing to strengthening the shoulder muscles, particularly the rotator cuff and scapular stabilizers. For severe separations (grades IV-VI), surgical intervention may be necessary to repair the ligaments and restore joint alignment, as suggested by 2. However, a recent systematic review and meta-analysis of randomized controlled trials 1 found that conservative treatment provides a viable alternative with fewer complications and similar long-term outcomes for Rockwood type III ACJ dislocation. Recovery typically takes 2-12 weeks depending on severity, with most patients returning to normal activities within 6-8 weeks for non-surgical cases. Surgery requires longer rehabilitation, often 3-6 months. The treatment approach balances the need to stabilize the joint while preventing stiffness and muscle atrophy that can occur with prolonged immobilization, as discussed in 3, 4, and 5. It is essential to consider individual patient factors and the latest evidence when developing a treatment plan for AC joint separation.