The AC (Acromio-clavicular) joint is a thick fibrous joint that connects the top of the shoulder blade to the outer end of the collarbone. The joint is required to be strong and supportive and is the primary way in which weight bearing forces are transferred from the upper limb to the rest of the skeleton. The joint is connected by three strong ligaments, the Acromioclavicular, Corococlavicular and Corocoacromial ligaments.
HOW DOES THIS INJURY OCCUR?
The primary mechanism that will cause this joint and it’s ligaments to be injured is a force that separates the shoulder away from the collarbone, usually in a downwards direction. This can occur from a fall into the ground where the top of the shoulder hits the ground first, a rugby tackle or a fall onto an outstretched hand. As with all injuries, there are many variations in severity. A grading system has been developed to classify AC joint injuries.
WHAT ARE THE SYMPTOMS?
After an AC joint injury there is usually immediate pain on the top of the shoulder, swelling and bruising. There is often loss of movement of the shoulder, and pain from putting weight through the arm or carrying heavy objects. In severe cases there is a visible lump on top of the shoulder, known as a ‘step deformity’. This is an obvious difference in height between the top of the shoulder and the collar bone. There is frequently pain felt when reaching across the body, as when putting on a seatbelt.
To confirm the diagnosis, your physiotherapist can perform some clinical tests and an X-ray can help to grade the severity of the injury. The classification that would be given to you by your physiotherapist or doctor help to determine the optimal course of action for each injury based in current research and available techniques.
There are different classification systems, some use four grades and other six. Injuries with a smaller number of ligament fibres being torn are given a lower grade classification, going upwards as further damage is incurred. Injuries classified as higher grades will require surgical repair.
HOW CAN PHYSIOTHERAPY HELP?
The role of physiotherapy in this case is to ensure the joint is supported and given a chance to heal naturally, while maintaining the strength and normal movement of the shoulder girdle. This is done initially by providing support to the joint. You may need to have your arm supported in a sling or brace for some of this time. Your physiotherapist can show you some taping techniques to add support.
Most AC joint sprains take six weeks to fully heal, although many patients report shoulder problems in future years. For this reason a comprehensive rehabilitation program is very important. More severe sprains are often treated with surgery to stabilise the joint and treat any possible fractures. Surgical repair will also require a proper rehabilitation program.
None of the information in this newsletter is a replacement for proper medical advice. Always see a medical professional for advice on your individual injury.
While pain and stiffness often go together, joint stiffness can occur on it’s own. Joint stiffness can limit your ability to perform usual tasks. For example, turning your neck to check behind you while driving. Stiffness can also be a warning sign that part of the body is vulnerable to future injury. There are actually many different causes of stiffness. We will explore a few of the reasons why you might not be feeling as flexible as normal.
Disuse and lack of movement
Our bodies are made to move. When we are not regularly moving them through their full range, they can begin to feel ‘tight’. This can be caused by a combination of the capsule that surrounds the joint tightening up and the muscles that surround the joint shortening and losing flexibility. Stiff and tight muscles can cause you to feel as though your joints are stiff, even if it is only the muscle length that is restricting the movement. Joint mobilizations, manipulation and muscle stretches/massage can have a significant effect in improving the symptoms.
The most important way to maintain full movement is to regularly move joints through their full range, which also helps to keep muscles and joints healthy. Your physiotherapist can advise you on how o best approach this with a targeted set of exercises.
OA is a degenerative disease, characterized A person with OA will usually feel stiff for around 15-20 minutes after being still. Physiotherapy programs to strengthen the muscles surrounding the joints, so as to help absorb weight-bearing forces, has been shown to have positive results on OA symptoms.
Inflammatory Related Stiffness
The inflammatory process is characterized by swelling and pain around a specific area. Usually this is a response to damage by the body. As an area swells, this will allow less space for movement and a sensation of stiffness, as anyone who has had sprained an ankle can attest to. Acute inflammation will cause swelling that increases over 24-48 hours and subsides gradually. Autoimmune disorders can cause the body to mistakenly have an inflammatory reaction where there has been no injury, with resulting pain and stiffness. Rheumatoid arthritis and ankylosing spondylitis are two examples of such disorders.
Stiffness caused by inflammatory disorders is characterized by feeling of stiffness after rest, particularly in the morning that can take longer than 30 minutes to subside. Inflammatory disorders unrelated to injuries are complex in cause and require collaboration with medical teams for best treatment outcomes. Acute injuries are best managed by following RICE protocols (Rest, Ice, Compression, Elevation). Speak to your physiotherapist for more information regarding a specific condition.
a breakdown of joint surface cartilage and the growth of bony osteophytes around areas of stress. While OA is increasingly common as we age, it is thought that the primary cause is abnormal load and stress to joint surfaces and not simply aging itself. As the joint space between two joint surfaces become uneven, joints affected by OA can feel stiff or even ‘blocked’.