Keywords: Acromioclavicular joint dysfunction, Shoulder Anatomy, Shoulder Examination, Physiotherapy, Special tests, Differential Diagnosis, ACJ Stabilisation.
This information has been displayed with the kind permission of Lennard Funk and SportsInjuryClinic. Parts of the pages have been copied from Shoulderdoc.co.uk and SportsInjuryClinic.net.
Clinically Relevant Anatomy
The AC joint is located at the tip of the shoulder where the acromion portion of the shoulder blade (scapula) and collarbone (clavicle) join together. The AC joint is not as mobile as the large main shoulder joint and only moves when the shoulder is overhead or across the chest (adducted). The joint is partly filled with a thick pad of cartilage, known as the meniscus, which allows the joint to move. The AC joint is stabilised by its capsule and additional ligaments (coraco-clavicular ligaments).
Characteristics and Clinical presentation
1. Pain superior lateral aspect of the shoulder.
2. Pain with over head activities.
- Acromioclavicular Joint Arthritis of the Shoulder
- Acromioclavicular Joint Dislocations
- AC Joint Osteolysis
Examination: Shoulder Assessment
Advice for patient
Advice varies depending on the cause of the pain. In the acute phase RICE guidelines apply and a sling may be provided for comfort. At this stage accurate diagnosis is necessary to guide treatment. The level of displacement is graded and some will require a period of rest to allow inflammation to settle and for ligaments to heal (Grade 1-3). In grades 4-6 early surgical intervention may be necessary. In lesser grades maintaining range of movement to prevent stiffness and then a gradual strengthening program is used to regain good function of the glenohumeral joint.
Below is an example of a possible problem list for a patient with an acromioclavicular displacement. All patients are different and you must tailor your findings to provide accurate, realistic objectives and treatments. To eliminate the symptom you must source the cause (ie instability- provide stability) and try to reduce/remove this. It then may be necessary to treat symptoms to settle everything down (Secondary trigger points caused by guarding and muscle spasm) .
- Pain with overhead motion.
- Pain over the ACJ.
- Reduced function.
- Reduced muscle strength.
- Decrease Pain
- Establish cause of pain over ACJ and treat accordingly.
- Increase function
- Increase muscle strength
- To reduce Pain – Advice, Relative rest, NSAIDS, Ice, Therapeutic ultrasound, Gentle ROM ie Pendular ex. .
- Click here to look at pain pathways and treatment options. Deep transverse frictions, therapeutic ultrasound, Tens over spinal nerve root, acupuncture.
- To increase function – functional exercises once strengthening and scapula setting has been achieved.
- To increase muscle strength – Isometric flex/ext,IR,ER. Can progress to isotonic therabands. Closed chain shoulder stability ex. Please see Professor Funks extensive exercise guide scapula stability exercises.
- Strengthen the rotator cuff and surrounding muscles to maintain optimal position of the shoulder to avoid excessive load/stretch of the acromioclavicular, coracoclavicular, coraco-acromial ligaments.
- Avoid painful activities and continuing strengthening to provide the stability needed from the musculature to compensate for lax ligaments.
- Be guided by your physio regarding return to sport. If you have pain on light palpation and extreme laxity you will certainly have pain, and potentially risk further serious injury, by attempting a contact sport.