The Trainer’s Room: Diagnosis, Recovery, and Treatment of AC Joint Sprains

During the first game of the season, against a tough BYU team, Oklahoma quarterback Sam Bradford was taken down at the end of the second quarter and landed on his throwing arm.

After the game, the Sooners released a statement saying that Bradford had sprained the AC joint in his throwing arm, and may be out for 2-4 weeks.

Now, after several weeks on the sideline, it appears he may return as early as this weekend against Miami.

[Update: The latest word as of Thursday afternoon was that Sam Bradford would not start this weekend -- but could possibly play -- against Miami as he continues to recover from the ac joint injury that has kept him out of action since the opener.]

ac joint injury treatment: ac joint sprain treatment, symptoms, diagnosis - type 1, 2, 3 | shoulder injuries denver

Photo credit: Nate Billings, The Oklahoman (via newsok.com)

The acromioclavicular joint  (AC joint) is a spongy tissue that connects the clavicle to the scapula, which makes an injury to this area extremely sensitive. In fact, the AC joint is the only area that connects the shoulder girdle to the rest of the body by forming a joint with the clavicle.

Mechanism of AC Joint Injury

Despite having full range of motion in the shoulder joint (the glenohumeral joint), the AC joint provides less motion.

The two most common ways to injure this joint are repetitive stress such as throwing a football or baseball, or an acute trauma to the lateral aspect of the shoulder joint, such as crashing to the ground after been tackled, as happened to Bradford.  

The AC joint is actually the second most commonly injured joint in the body, next to the glenohumeral joint.

In this article we will only be discussing the acute injury. When the force is applied to the lateral portion of the shoulder, the ligament connecting the clavicle to the scapula is either stretched, as in a sprain, or torn, as in an AC joint separation. 

AC joint sprains are typically classified into 3 groups:

  • Grade 1 AC joint sprain: A partial disruption of the AC joint, simply a stretch or sprain of the AC joint ligaments.
  • Grade 2 AC joint sprain: A partial injury to the AC joint capsule and coracoclavicular ligament (another ligament connecting the clavicle to the scapula)
  • Grade 3 AC joint sprain: A complete tear or disruption of the AC joint capsule and ligaments. A disruption or the ligament will require surgery and you will have a noticeable separation of the clavicle to the scapula.

ac joint injury treatment: ac joint sprain treatment, symptoms, diagnosis - grade 1, 2, 3 | shoulder injuries denver

AC joint sprain grades image credit: Earthopod.com

AC Joint Sprain Symptoms and Diagnosis

Common symptoms of an AC joint sprain are pain and tenderness of the AC joint.

To find this area on yourself, use two fingers to feel along the clavicle towards the shoulder. You will feel a noticeable small separation between your collarbone and the stiff boney prominence just before you reach the the head of the humerus, which is the joint space. Press lightly on that area to feel the sponginess of the joint.

Pain in the joint because of touch or movements of the shoulder are the primary indicators of an injury to the AC joint. It is also common to see bruising and swelling of the AC joint after the injury. 

Someone with an acute injury to the AC joint will try to keep the arm close to the body, as if in a sling to avoid movement and pressure to that joint.

Other indicators of an AC joint injury are similar to orthopedic tests your doctor will run to identify an AC joint separation. Any overhead activities will exacerbate the pain, such as incline bench press, or simply getting something in the overhead cupboard.

Another self test you can do at home is to take the web of your hand on your uninjured arm and place it below the bicep of the injured arm and resist yourself trying to bring the injured arm across the body. If there is pain in the AC joint, this is a good indication of injury. 

If you have pain in this joint, it is best to see your doctor to determine if there is an injury to the AC joint, the severity, and the course of treatment. Your doctor will use orthopedic tests, feel the joint, and test your range of motion to come to a diagnosis.

The shoulder is a tricky joint and there can be a multitude of different injuries in this area, so a proper diagnosis is key for a quick recovery. Your doctor will also take x-rays of the AC joint to rule out a fracture, or complete tear of the ligament. It is not uncommon for the doctor to take an x-ray of both of your shoulders to determine if there is a difference from side to side.

Another common technique that we use at Mountain View Pain Center is to take a second X-ray of the injured joint with a weight in the hand to determine if there is laxity of the ligament.

AC Joint Injury Treatment and Recovery

The key to a proper recovery is rest. Dropping weights in your workouts, or simply laying off for a few days, will not correct the problem.

If you want this injury to heal then you must not be involved in any sporting activities at all for at least two weeks, if not more, depending on the severity of the injury.

You should not only avoid sporting activities but all strenuous activities for the shoulder, especially anything that involves lifting or reaching overhead.

When the initial injury occurs, get ice on it immediately. If you cannot get straight to your doctor, then try to keep the arm close to your side as if in a splint to avoid tension on the joint.  This is something you do not want to let go for very long. If there is a small tear in the ligament and you continue to play your sport or work out then you risk a complete tear, and a much longer recovery.

In many cases after an AC joint injury, you may receive a cortisone shot in the tissue around the joint, or directly in the bursa to relieve pain. This may get you on the field without pain for that game; however, for long-term treatment we do not recommend it.

Cortisone shots over time will actually weaken the tendons and ligaments. If we are dealing with an already weak ligament then the chance for further damage increases. Cortisone shots simply mask the pain but do not actually treat the problem.

If you are only planning on getting a shot and continue to work out and play, expect further problems down the road. At Mountain View Pain Center, we commonly work side by side with a pain management doctor to give a shot for the acute pain, while we work to rehab the area to stabilize the joint.

As with any acute injury, the two main problems are pain and swelling. To treat these both simultaneously at Mountain View Pain Center, we use a special treatment called Interferential Therapy around the shoulder joint. This works by removing not only pain, but also the edema (swelling) in the area.

Another therapy we use is called Microcurrent therapy to speed up the healing process of the stretched ligament. Coupled with the rehab exercises, this helps the stretched ligament to heal properly and regain stability.

The next step is to apply kinesio-tape to the area. We prefer kinesio-tape at our office because it will remove swelling from the area without limiting the range of motion.  We tape to hold the AC joint down, so the ligament will shorten and heal, thus preventing further or chronic injury to the AC joint.  This tape can be worn for several days, and even stays on in the shower. You can also apply any topical analgesic or pain relief gel directly over the tape.

For a Grade 1 or Grade 2 sprain, with proper treatment, you should be pain free within about three weeks.  Remember, just because the pain is gone does not mean the instability is gone. You must continue treatment for full rehabilitation.

At Mountain View Pain Center, once the initial pain is reduced, hopefully in the first week, we begin with exercises to restore normal motion to the joint and prevent the buildup of scar tissue. After the injury has begun to heal, you should start with light weight, high repetition exercises of the shoulder joint, such as external rotations, abductions, and retractions.

Do not by any means go straight back to the gym and start doing heavy lifts, such incline bench press, right away. While the initial workouts are a good way to test what you can and cannot do, we recommend staying away from any heavy chest, flyes, and shoulders for another month.

If you are a quarterback or pitcher, you can begin to lightly throw the ball at practice, starting with short passes. Give the shoulder ample time to rest and do not go straight into a game without proper warm up.

We encourage our athletes to return to our office before a game to be properly treated and taped. Also, ice after you are done playing, even if it does not hurt right away. You want to avoid pain and inflammation tomorrow.

If you have a Grade 3 sprain, or complete separation, you may need to be referred to an orthopedic surgeon. 

Nutrition for Soft Tissue Injuries

  • Glucosamine Sulfate 1000mg or Glucosamine with MSM
  • Max joint Relief
  • We always recommend for any inflammation: fish oils, ginger, boswellia, and turmeric.

In any case, an AC joint sprain is not something you want to just let “heal itself” because you are constantly using this joint and the chance of a chronic sprain will increase the longer you go without treatment.

Although a nuisance and a painful problem, this is very treatable and generally you can be back in the game within 2-6 weeks. 

Look to see Bradford back in the game against Miami or Baylor. Depending on how the treatment has progressed and what Bob Stoops and Bradford’s doctors think is best for Bradford’s long term career, we will see. As a fan, I would like to see him back sooner than later; however, giving the shoulder ample time to heal is the most important thing.

It will definitely be a test for the shoulder in either case. Boomer Sooner!

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If you would like further information on supplements or vitamins for similar types of injuries, contact us or we can direct you to www.maxmusclehighlandsranch.com

This article contains the opinions and examples of treatment plans for plantar fasciitis from Mountain View Pain Center in Denver, CO, and is not intended as a substitute for specific medical advice from a doctor regarding your individual injury or condition. If you have any further questions or concerns feel free to contact our office or leave a comment below.

 


The Trainer’s Room is written exclusively for Midwest Sports Fans by Denver chiropractors Dr. Niall McNally and Dr. Ihsan Erhuy of the Mountain View Pain Center in Denver, CO. You can contact them by leaving a comment below or sending an email to info@mountainviewpaincenter.com.

Dr. Niall McNally is certified in chiropractic neurology and has a strong background in sports iplantar fasciitis treatment Denvernjuries and in the rehabilitation of common nagging athletic problems. Dr. McNally also is trained in pediatrics, orthopedics, and nutrition.

He graduated from the University of Central Oklahoma and successfully completed his Doctor of Chiropractic degree at the Parker College of Chiropractic in Dallas, TX. A very active athlete, Dr. McNally played hockey up into the junior level. In fact, it was his love for hockey, and the Colorado Avalanche, that originally gave him the idea to one day practice sports medicine and chiropractics in the area.

plantar fasciitis treatment DenverDr. Ihsan Erhuy specializes in motor vehicle accident injures, back, neck, and extremity problems, as well as treating pregnant patients and children. He is certified in the Diversified, Gonstead, Thompson, Upper Cervical, Activator, Sacral Occipital, Applied Kinesiology, Soft Tissue techniques.

Originally from Adana, Turkey, Dr. Erhuy graduated from the University of Arizona and also susuccessfully completed his Doctor of Chiropractic degree, along with his bachelor of science in health and wellness, at the Parker College of Chiropractic in Dallas, TX.



About Mountain View Pain Center

At Mountain View Pain Center we are committed to relieving your pain and restoring you to good health and wellness. We are able to do this by combining expert advice, the highest quality chiropractic care currently available, advanced soft tissue work and state-of-the-art rehabilitation programs. At our office you will experience the benefits of a dynamic team approach and receive a level of care which is virtually unmatched elsewhere. With this powerful combination our chiropractors can dramatically improve your life and the lives of your friends and family. The Mountain View Pain Center is located in Centennial, CO which allows us to provide convenient chiropractic care and rehabilitation treatment to Aurora, Centennial, Denver, Lakewood, Parker, Littleton, Highlands Ranch, Cherry Hills, Lone Tree, and Green Wood Village.

Comments

  1. i have a 3rd degree ac joint sprain which happened about a year ago, it has been giving me some problems, mainly pain during workouts. I play division 2 soccer. I was referred to an surgeon who said the surgery can be done, but it was up to me. My question is does it matter when i get the surgery? rather than getting it now when it will effect my soccer season oppose to getting it 2 years down the road when my college career is over. Will that make the results different?

  2. I live north of Denver. Three years ago I rolled an ATV and recieved a 3rd degree AC jt seperation. I recieved no treatment initially. I am doing well except I get headaches after workouts or physical excersion. Can you help me. Please detail a treatment plan and what you hope to accomplish.
    Thank you
    Dennis Hermesch

  3. Sorry about the late replay. First off who diagnosed you with a grade 3 AC joint sprain? Did you have an MRI done and are there any torn ligaments. With a grade 3 you are looking at a tear in the ligaments and often some displacement of the clavicle. The next thing is how is the range of motion in the shoulder? Any strength loses, clicking, or popping. When we see a grade 3 tear I will typically consult with the patient and an orthopedic surgeon. In many case a patient will want to try to avoid a surgery and start with conservative care first. Unfortunately with the injury happening 3 years ago there is going to be some significant scar tissue build up. This will be your first step removal of inflammation and scar tissue. The exercises at this point will more than likely cause more harm than good until we can remove that. There are several ways to remove scar tissue, such as ultrasound, graston, or ART. After the initial few visits I would slowly move the patient into passive ROM exercises, and isometric exercise. Once these become easy We move onto the active range of motion exercises. With this type of injury I would avoid overhead exercises and incline chest exercise. The initial step of the MRI and exam will determine if it is safe to mobilize the joint. If there is a tear in the ligament I would not manipulate the joint. Hopefully this helps get you started. As for the surgery portion more often than not it becomes up to the patient, but with a complete tear no amount of therapy will get the ligament to regenerate, so it comes down to how well can you use the shoulder, with no discomfort and does it affect your daily activities.

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