Acromioclavicular Joint Pain

Fall on tip of shoulder or FOOSH (older adult)

What are the primary causes of Traumatic AC Joint Sprains

grade 1 ACJ sprain

point tenderness and pain w/ movement; no disruption of AC joint or laxity

grade 2 ACJ sprain

tear or rupture of AC ligament, partial displacement of lateral end of clavicle; pain, point tenderness and decreased ROM (abduction/adduction)

grade 3 ACJ sprain

Rupture of AC and CC (coracoclavicular) ligaments, strain deltoid and trap

grade 4 ACJ sprain

posterior dislocation of clavicle

grade 5 ACJ sprain

- loss of AC and CC ligaments

- tearing of deltoid and trapezius attachments

- gross deformity, severe pain

grade 6 ACJ sprain

displacement of clavicle behind the coracobrachialis

- Local pain at AC joint and/or other involved ligaments

- Swelling

- Tenderness to palpation

- May have a painful arc (> 120 degrees)

- "Step-down" deformity

What are signs/symptoms of ACJ sprains

>120 degrees

what is the painful arc for ACJ sprain

AC Joint "Step Down Deformity"

- Repetitive loading

- Degenerative changes

What are common causes of Atraumatic AC Joint Pain

- Painters, mechanics, athletes, etc.

- Bench pressing

Who is at greater risk for repetitive loading based atraumatic ACJ pain

FOOSH or direct blow

What are subjective examination findings associated with traumatic ACJ pain

Swelling/deformity over AC joint

What are observation examination findings associated with traumatic ACJ pain

Pain with end-range flexion and horizontal ADD

What are AROM examination findings associated with traumatic ACJ pain

Pain at end range flexion and horiz add

What are PROM examination findings associated with traumatic ACJ pain

Grade III has deltoid and trapezius involvement, MMT painful in acute sprains

What are resistive examination findings associated with traumatic ACJ pain

No laxity grade I, grades II and III will have AC laxity

What are joint mobility examination findings associated with traumatic ACJ pain

Isolated tenderness over AC joint

What are palpation examination findings associated with traumatic ACJ pain

Repetitive, overuse, may be in PT for a GH issue primarily

What are subjective examination findings associated with atraumatic ACJ pain

Possible bony changes/enlargement

What are observation examination findings associated with atraumatic ACJ pain

Pain with end-range flexion and horizontal adduction

What are AROM examination findings associated with atraumatic ACJ pain

Pain at end range flexion and horiz add

What are PROM examination findings associated with atraumatic ACJ pain

No perceptible changes

What are resistive examination findings associated with atraumatic ACJ pain

Hypomobility typically in multiple directions

What are joint mobility examination findings associated with atraumatic ACJ pain

Isolated tenderness over AC joint

What are palpation examination findings associated with atraumatic ACJ pain

Signs of obvious pain, swelling, deformity

What are the AC Joint Special Orthopedic Tests for traumatic AC sprains

- Pain located at ac joint with some referral to superior shoulder/upper trapezius

- Pain and tenderness to palpation

- Cross body adduction often painful

- AC spring testing often painful

What are the AC Joint Special Orthopedic Tests for atraumatic AC sprains

Nonsurgical treatment

What does treatment of traumatic grades 1 and 2 ACJ sprains entail

General consensus is non-surgical management = to surgical

What does treatment of traumatic grade 3 ACJ sprains entail

- Surgical management

- AC fixation with pins or plates and coracoclavicular fixation with nonabsorbable suture or metallic screws, or removal of distal end of clavicle

What does treatment of traumatic grades 4,5 and 6 ACJ sprains entail

To reduce direct pressure and traction at the AC joint to allow ligament(s) to settle down

What is the primary goal of physical therapy treatment for traumatic ACJ sprains

- Ice, sling, NSAIDs, analgesics, modalities

- Grades 1-3 (non-operative) may require 1-3 weeks of immobilization (for pain)

- Full return to activity in 6-12 weeks.

What are key points/considerations about PT treatment of traumatic ACJ sprains

Modified Weaver-Dunn procedure

What is a surgical procedure used to correct Chronic symptomatic A-C instability through C-C fixation + transfer of the C-A ligament to the distal clavicle

Improve mobility of AC and surrounding soft tissues, joints to reduce direct load on AC joint

What is the primary goal of physical therapy treatment for atraumatic ACJ sprains

- Activity modification

- Manual therapy

- Exercise

What are the 3 main methods to Improve mobility of AC and surrounding soft tissues, joints to reduce direct load on AC joint with atraumatic ACJ pain

Address overhead or repetitive aggravating activities

What are key considerations for activity modification for the PT management of atraumatic ACJ pain

- Often observed are impairments in RTC strength, scapular musculature

- Flexibility of the thoracic spine, pectoralis muscles, etc. may also be present

What are key considerations for exercise prescription for the PT management of atraumatic ACJ pain

Reaching and direct pressure over the shoulder

What should be restricted with traumatic ACJ sprains

Limit lifting to 10–20 lb held close to the body

What is the lifting limit with traumatic ACJ sprains

for pain control

Why is immobilization used initially with ACJ sprains

Avoid sleeping on either side

What sleeping position should be avoided with ACJ sprains

General shoulder conditioning

What type of conditioning should be included in ACJ sprain rehabilitation

by 2-3 weeks

When should full PROM be achieved after an ACJ sprain

ROM and pain-free strengthening, progressing from isometrics to PREs

What are the key PT interventions for ACJ pain/sprains

immediately

When should ROM and isometrics begin for ACJ pain/sprains

As tolerated without pain or swelling

How should function and strengthening progress for ACJ pain/sprains

6 sessions

How many OMPT sessions were used in the Harris et al. (2012) study

Mostly the AC joint, with adjacent joints also treated

What joints were primarily treated with OMPT?

Excellent short- and long-term results for pain and function

What were the results of OMPT for atraumatic ACJ pain

Caudal, A/P, and P/A glides

What manual therapy techniques were used for Manual Therapy for Injection-Confirmed Atraumatic ACJ Pain

Arm at side → functional positions → loaded and overhead positions

How were the manual therapy positions progressed for Manual Therapy for Injection-Confirmed Atraumatic ACJ Pain