The Acromioclavicular (AC) joint may be a source of pain after injury or gradually become painful. After injury the joint can be sprained or it may be dislocated. This information is about the painful AC joint without instability. Grade 1 traumatic injury of the AC joint may occur after direct impact, without instability. AC joint pain may also come on gradually with symptomatic AC joint arthritis or distal clavicle osteolysis. Sometimes these conditions may gradually occur after a traumatic initial injury.

Initial treatment

• Many cases settle without surgery

• Treatments include activity modification, time (more than 6 months often), pain and anti-inflammatory medication and cortisone injection.

• If pain recurs after cortisone injection and symptoms are significant, AC joint debridement and trimming the outer end of the clavicle may be indicated.

AC joint surgery

• Performed under general anaesthetic

• Either one night in hospital or day surgery

• Sometimes done arthroscopically, other times through a small incision over the AC joint. This depends on individual factors.

• A sling is worn for 1 – 2 weeks following surgery.

• The sling may be removed for showering and dressing. You should not drive wearing a sling.

Rehabilitation

• After a period of sling use, the arm may be used in comfort range and you may drive.

• Physiotherapy is sometimes used to work on scapular control, shoulder range of movement.

• When more than 70% range of motion is achieved, usually around 6 weeks from surgery, light strengthening may begin.

• Initially strengthening may be isometric or theraband internal rotation, external rotation, shoulder adduction strengthening.

• If more strength is required for return to work or sports, then gym strengthening may be gradually increased after 2 or 3 months from surgery depending on progress.

Expectations

• The goal is for the shoulder to feel around 80% right around 4 – 6 months from surgery, and 90% right or better 9 – 12 months from surgery.

• Sometimes it can take a long time for all aching to fully resolve.

Return to work guidelines

Often the initial return to work is part-time hours and modified duties, gradually building up.

• Sedentary work with arm in sling: 10 days post surgery

• Light two-handed duties and driving: 2 – 3 weeks post surgery

• Medium lifting below eye level with narrow arm span: 6 weeks post surgery

• Heavy work and collision activities (eg rugby): 2 – 3 months post surgery, depending on progress.