AC Joint Separation Treatment Options

Injury to the acromioclavicular (AC) joint is known as a shoulder separation. It is not an injury to the main shoulder joint, called the glenohumeral joint. The AC joint is where the collarbone meets the high point on the shoulder blade called the acromion. AC joint separation occurs when the ligaments that hold together the acromioclavicular (AC) joint in the shoulder are stretched or torn causing the separation of the collarbone and the shoulder blade. This causes the bones to separate from each other. There are two types of ligaments, the AC ligaments and the coracoclavicular (CC) ligament.

Shoulder separations are common in young male athletes between the ages of 20 and 30. They are one of the most prevalent shoulder injuries in contact sports. AC joint separations have also been found in high numbers during noncontact sports such as cycling or triathlon. They are typically caused by a fall the shoulder. However, an auto accident can also cause a shoulder separation.

A mild AC joint separation may cause only minor pain and swelling, while a more severe injury can significantly limit shoulder movement, cause shoulder instability and severe shoulder pain. Treatment of AC joint separation depends on the severity of the injury, but can range from rest, ice and medications to surgery. Most people can recover from a shoulder separation within 2-12 weeks.

What are the treatment options for an AC joint separation?

Treatment options vary depending on whether the injury is acute or chronic. An acute injury is one that presents within 3 weeks of trauma

• Mild injuries are usually a sprain or partial tear of the AC ligaments. Mild injuries are treated with rest, ice and over the counter NSAIDs – anti-inflammatory medications to reduce pain and swelling. You may use a shoulder sling for a few weeks to hold the bones in the correct position while they heal. However, it is important to start range of motion exercises to prevent a frozen shoulder, when the shoulder gets stuck in place. Petrigliano will order physical therapy once the ligaments have healed. This will help strengthen and improve the mobility of the shoulder.
• More serious injuries involve AC ligament tears and sprains or tears of the CC ligament causing the bones to be out of alignment. A trial of nonoperative treatment and stabilization with an AC joint brace for several weeks will immobilize the joint and allow healing. Surgery is reserved for those who remain symptomatic.
• Severe shoulder separations completely tear both the AC and the CC ligaments. Surgery will be necessary. The goal of surgery is to remove any damaged tissues and reconstruct the joint, allowing it to function more normally.

What are the indications for surgery?

If you have severe pain, arm or finger weakness, numb or cold fingers, significant difficulty moving your arm or a lump on the top of your shoulder you may need immediate shoulder surgery. Surgery may also be considered if there is a severe deformity, persistent pain or significant shoulder instability after nonsurgical treatment.

Surgical treatments for AC joint separation

Surgery for AC joint separation usually involves arthroscopic repair reconstruction of the torn ligaments and shaving the end of the collarbone to eliminate rubbing against the shoulder blade. This surgery is also the best option when pain or instability persists after nonsurgical treatment even when the condition is chronic, but tissue augmentation (a graft) may be needed to reconstruct the ligaments.

After surgery, a sling will be needed for about three weeks. Rehabilitation begins after sling removal and involves limited range of motion with no activities of daily living for the first six weeks after surgery, and free range of motion six weeks after surgery.

Physical therapy is important to regain full shoulder range of motion and strength. The recovery time can vary depending on the severity of injury, but most patients are generally able to recover and return to regular daily activities within 3-6 months and return to sports no sooner than 4 months after surgery. However, there are cases of continued pain after treatment when the trauma that caused the separation also damaged the cartilage cushion between the bones or caused post-traumatic arthritis.

Why choose Dr. Petrigliano?

Dr. Frank Petrigliano is an orthopaedic surgeon who was fellowship trained in sports medicine and shoulder surgery at the prestigious Hospital for Special Surgery where he provided care to athletes of all ages. He currently serves as the head team physician for the LA Chargers football team and associate team physician for UCLA Athletics. Dr. Petrigliano is a renowned orthopaedic surgeon and researcher who employs state of the art treatments and procedures to get you back to your active life and back to sport. He always treats his patients with compassion and respect. Dr. Petrigliano is located in Santa Monica California, and serves greater Los Angele and the South Bay. Contact Dr. Petrigliano to schedule a consultation today.