The acromioclavicular (AC) joint connects the collarbone (clavicle) and the shoulder blade (acromion) at the top of the shoulder. An AC joint sprain occurs when the ligaments stabilizing this connection are stretched or torn. These injuries frequently result from direct falls onto the shoulder or landing on an outstretched arm.
Understanding an AC Joint Sprain
AC joint sprains are classified by ligament damage severity. A Grade 1 sprain involves mild ligament stretching, often resulting in minor pain, tenderness, and swelling at the top of the shoulder. The shoulder remains functional with no visible deformity.
A Grade 2 sprain indicates a partial tear of the acromioclavicular and potentially coracoclavicular ligaments. Symptoms include moderate to severe pain, more noticeable swelling, bruising, and limited shoulder movement. A small, visible bump may appear due to slight clavicle displacement. Grade 3 sprains involve a complete tear of both ligaments, leading to significant joint separation. This results in severe pain, significant swelling, and a pronounced deformity. Movement is greatly restricted, and the shoulder may feel unstable.
Immediate Steps for Recovery
Upon suspecting an AC joint sprain, immediate actions can help manage pain and reduce swelling. The RICE protocol—Rest, Ice, Compression, and Elevation—is a common first aid approach. Resting the injured shoulder prevents further damage, while applying ice packs for 10-15 minutes can help reduce pain and inflammation. Compression, often with a bandage, minimizes swelling, and elevating the arm above heart level aids in reducing fluid accumulation.
Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can assist with pain relief and inflammation. It is important to seek professional medical attention promptly, as a healthcare provider can accurately diagnose the sprain’s grade and recommend the most appropriate treatment plan.
Conservative Treatment Methods
For many AC joint sprains, particularly Grade 1 and Grade 2 injuries, conservative treatment methods are effective. Initial management often includes immobilization, typically using a sling to support the arm and allow the injured ligaments to heal without stress. For Grade 1 and 2 sprains, sling use is typically for comfort and short-term, lasting a few days to three weeks. Pain management may involve prescribed medications or ongoing over-the-counter pain relievers as needed.
Protecting the joint from further injury during the healing process is essential. This means avoiding activities that place stress on the shoulder, such as heavy lifting, reaching overhead, or movements that cause pain. The duration of restricted activity depends on the sprain’s severity, with Grade 1 injuries potentially recovering in a matter of days to weeks, and Grade 2 injuries taking several weeks. Some Grade 3 injuries can be managed non-surgically, though recovery is slower and may involve sling immobilization for three to four weeks. Conservative treatment aims to allow ligaments to naturally repair, minimizing discomfort and preventing complications.
Rehabilitation for Full Recovery
Following the initial healing phase, rehabilitation focuses on regaining full shoulder function. Once pain permits, transition from immobilization to gentle range-of-motion exercises, typically within 7-14 days for Grade 1 and 2 sprains. Early exercises include pendulum swings, where the body moves to gently swing the relaxed arm forward, backward, and side-to-side, increasing mobility without stressing the joint. Wall slides can also restore overhead motion by having the patient slide their hand up a wall.
As mobility improves, the rehabilitation program progresses to strengthening exercises for the shoulder and surrounding muscles. Exercises targeting periscapular muscles and rotator cuff are important for stabilizing the AC joint and preventing re-injury. Examples include resistance band exercises for external and internal rotation, as well as scapular retractions where shoulder blades are squeezed together. Gradually increasing intensity and range of motion while listening to the body’s signals helps ensure a safe and effective return to full activity. This progressive approach rebuilds strength and endurance, preparing the shoulder for more strenuous demands.
When Surgery is Necessary
Surgical intervention for an AC joint sprain is typically reserved for severe cases where conservative treatments are insufficient. This often includes severe Grade 3 sprains, especially in active individuals or athletes, and less common Grade 4-6 injuries that involve significant clavicle displacement. The primary goals of surgery are to realign the joint and repair or reconstruct torn ligaments.
Surgical recovery is generally more involved and lengthy than non-surgical healing. Full recovery after AC joint surgery can take approximately four to six months, with some individuals requiring up to seven to nine months. This period often includes several weeks of sling immobilization, followed by extensive physical therapy to restore strength and range of motion. While surgery can restore a higher level of function in severe cases, it also carries a longer rehabilitation timeline.