ACJ Separation

ACJ Separation: A Detailed Overview

Acromioclavicular (AC) joint separation is a common injury that affects the shoulder region, often resulting from trauma or direct impact to the shoulder. This condition, often mistaken for shoulder dislocation, can range from mild discomfort to severe pain and instability that hinders daily activities.

In this detailed overview, we will explore what ACJ separation is, its causes, symptoms, diagnosis, and various treatment options, including whether surgery is always necessary.

What is ACJ separation?

The acromioclavicular joint is located at the top of the shoulder, where the clavicle (collarbone) meets the acromion (a bony prominence of the shoulder blade). AC joint separation occurs when the ligaments supporting this joint are damaged or torn due to a sudden jolt or impact. This can lead to a noticeable gap or displacement between the clavicle and acromion, resulting in pain and instability.

What causes ACJ separation?

AC joint separation is commonly caused by a traumatic event, such as a fall onto an outstretched arm, or a direct blow to the area. Sports-related injuries, especially in sports such as football, cycling, snowboarding or skiing, increase the risk of ACJ separation. The tearing of ligaments responsible for stabilising the AC joint can vary in severity, leading to different grades of separation.

What are the symptoms of ACJ separation?

The symptoms of ACJ separation can range from mild to severe, depending on the extent of ligament damage. Common signs include:

  • Pain: Persistent pain around the AC joint, particularly during shoulder movement or when pressure is applied to the area.
  • Swelling: Swelling and tenderness over the AC joint due to inflammation caused by the injury.
  • Prominent collar bone: In more severe cases (Grade 3-5 injury), the ligaments that hold down the clavicle may rupture and a noticeable bump or deformity may be visible at the top of the shoulder.
  • Limited range of motion: Difficulty or pain while moving the shoulder, especially when reaching overhead or across the body.
  • Instability: A feeling of instability or weakness in the shoulder, making daily activities challenging.

How is ACJ separation diagnosed?

X-rays are commonly used to visualise the AC joint and surrounding structures, helping determine the severity of separation. In more complex cases, magnetic resonance imaging (MRI) scans may be performed to provide detailed images of ligament damage and joint displacement. Then, your Specialist can advise on either non-surgical or surgical treatments.

What are the treatment options for ACJ separation?

The treatment approach for ACJ separation depends on the severity of the injury. In mild cases, the RICE protocol (rest, ice application and compression), along with anti-inflammatory medication can help alleviate pain and reduce swelling. Immobilising the shoulder with a sling or brace may also be recommended for aiding the healing process.

Physical therapy with carefully prescribed rehabilitation exercises is crucial for restoring strength, stability, and range of motion in the affected shoulder.

If your London Shoulder Specialist diagnoses a more severe injury (Grade 3 or above), then surgery will be recommended, especially for those in heavy manual jobs or high-performance overhead athletes.

Is surgery always necessary for ACJ separation?

Surgery is not always necessary for ACJ separation, especially in mild to moderate cases. Conservative treatments, including rest, physiotherapy, and pain management, are often effective in promoting healing and restoring function. However, in severe cases with significant ligament damage or persistent instability, surgical intervention may be recommended to realign and stabilise the joint.

Usually, surgery will involve an incision on top of the shoulder, and the joint is put back into its correct position, sometimes using an implant to hold it together while the ligaments heal and any damage to the end of the collar bone may be tidied up. It will take around 12 – 16 weeks for a full recovery and return to activity/sports, with a plan of physical therapy during that time. If surgery is not chosen immediately, there may be an opportunity to have it at a later time.

Can ACJ separation be prevented?

While it may not be entirely preventable, certain measures can reduce the risk of ACJ separation. Athletes participating in contact sports should use appropriate protective gear, such as shoulder pads or braces, to minimise the impact on the shoulder.

Building and maintaining shoulder strength through targeted exercises can enhance joint stability and reduce the risk of injury. Also, ensuring proper technique during sports and activities can help avoid unnecessary stress on the shoulder joint.

Can lifestyle changes help manage ACJ separation?

Adopting preventive measures and lifestyle changes can further reduce the risk of ACJ separation and promote long-term shoulder health. Excess body weight can strain the shoulder joints, making them more susceptible to injuries. Maintaining a healthy weight reduces this risk as well as engaging in regular, low-impact exercises to strengthen the muscles surrounding the shoulder joint.

ACJ separation can be diagnosed by your London Shoulder Specialist who can recommend an appropriate treatment plan and ways to effectively manage your condition.