Treatment for Grade 2 AC Joint Injury
Grade II (Rockwood type II) acromioclavicular joint injuries should be treated nonoperatively with initial sling immobilization for comfort followed by early functional rehabilitation, as this approach consistently yields excellent outcomes with full return of function. 1, 2
Initial Management
Conservative treatment is the definitive approach for Grade II AC joint injuries:
- Apply sling immobilization initially for comfort only, typically for a short period (days to 1-2 weeks maximum) 1, 2, 3
- Begin ice application immediately to reduce pain and inflammation 2
- NSAIDs can be used for pain control during the acute phase 2
Rehabilitation Protocol
Early functional rehabilitation should begin as soon as pain allows:
- Remove the sling once acute pain subsides and initiate range of motion exercises 3
- Progress to strengthening exercises focusing on the trapezius and deltoid muscles, which provide dynamic stability to the AC joint 2
- Emphasize full rehabilitation to ensure return to sport without deficits 3
Expected Outcomes
The prognosis for Grade II injuries with conservative management is excellent:
- Full return of function is the expected outcome following these injuries 1
- Patients typically have manageable long-term symptoms without any intervention 3
- Rapid and full return to play is expected, even in athletes 4
When Surgery is NOT Indicated
Operative intervention has no role in acute Grade II AC joint injuries:
- There is consensus that type I and II injuries should be treated nonoperatively 5
- Surgery does not improve pain, strength, or motion compared to conservative treatment 3
- The only advantage of surgery is anatomic reduction, which does not correlate with functional improvement 3
Long-Term Considerations
Some patients may develop chronic symptoms requiring delayed intervention:
- A minority may require steroid injection for chronic pain from degenerative changes at the AC joint 3
- Distal clavicle excision can be considered for persistent symptomatic AC joint arthritis that develops years after the initial injury 3
Common Pitfalls to Avoid
- Do not perform surgery acutely - Grade II injuries are definitively managed nonoperatively, and surgery offers no functional benefit 5, 3
- Do not immobilize for extended periods - Prolonged sling use leads to stiffness; early mobilization is key 1, 2
- Do not confuse Grade II with Grade III injuries - Grade III injuries remain controversial regarding operative versus nonoperative treatment, but Grade II injuries have clear consensus for conservative management 4, 5