Shoulder Joint Injuries Acromioclavicular Joint and Sterno Clavicle

The Acromiclavicular joint, or AC joint, is the joint at the tip of the shoulder. It is where the lateral end of the clavicle (collarbone) meets the acromion, which is part of the scapula (shoulder blade).

The sternoclavicular joint, or SC joint, is at the opposite end of the clavicle just below the neck. This is where the medial end of the clavicle meets the sternum.

These two joints form part of the shoulder complex, alongside the glenohumeral joint and scapulothoracic joint.

Definition / Causes

The AC joint can be painful as a result of various conditions or injuries including osteoarthritis or joint sprains. They can also be commonly associated with other shoulder conditions such as rotator cuff injuries.

The SC joint is less commonly affected as the ligaments surrounding this joint are very strong. It normally requires a high impact trauma such as a fall during contact sport or a motor vehicle accident to damage the SC joint.

These joint can be painful as a result of various conditions or injuries including:

• Osteoarthritis – This condition is a result of loss of cartilage at the joint. This is related to degenerative changes and occurs more commonly with aging.
• AC joint separation – This is the result of a traumatic incident such as a fall. The joint separation is assessed on X-ray and graded accordingly. The grade will determine whether conservative or surgical management is required.
• AC joint sprain/ irritation – Irritation of the joint can occur as a result of repetitive overhead activities (eg. painters, throwers) 
• SC joint sprain – The ligaments surrounding the joint are sprained as a result of a fall or impact injury.
• SC joint dislocation – The joint dislocates as a result of trauma. This requires urgent medical intervention
• Fractures – Can occur anywhere along the clavicle as a result of trauma (fall, sporting injury, car accident etc)

Signs & Symptoms

All injuries to the AC joint or SC joint will present as pain in the affected area.

More traumatic injuries such as fractures or dislocations can present with a visible deformity. AC joint separation will have a step deformity as shown below.

The AC joint separation is graded according to a set classification system known as the Rockwood classification. The grade will determine if surgery is required to stabilise the AC joint. Type 1 and 2 injuries are treated conservatively, type 3 injuries can be treated either conservatively or surgically and type 4 or above is treated surgically.

Treatment

Physiotherapy treatment is aimed at reducing pain, restoring range of motion, strength and function in the shoulder complex.

Your physiotherapist will guide you through an appropriate rehabilitation program which aims to restore the function in your shoulder. Pain management education and techniques will be included in your treatment plan. This may include rest from certain aggravating activities, ice/heat and hands on treatment.

Medical management may include the use of medications and corticosteroid injections. Surgery is required for patients with higher grade AC joint separations or for those patients who fail to improve with conservative management.

Prevention

Injury as a result of a traumatic incident is unfortunately unavoidable. However, for symptoms of gradual onset then you can do the following to help yourself:

• Temporarily stop any aggravating activities if mild symptoms develop – this may include reducing overhead activities
• Maintain good posture during daily activities
• Maintain good strength and mobility around your shoulder joint/muscles
• Healthy lifestyle and good sleep hygiene is also beneficial to the shoulder complex

Melbourne Hand Therapy Can Help You

Our physiotherapists are highly skilled in assessing and treating the shoulder. The sooner you book an appointment for assessment and treatment, the better. If you prolong receiving treatment, you are likely to develop compensatory movements, which could result in a longer recovery time.

So don’t delay and click the link below to book an appointment with one of our upper limb physiotherapists TODAY!

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