Damage to the ligaments in the upper shoulder holding the outer collar bone (clavicle) on to the shoulder (acromion), usually associated with a falling injury. Can be grade I (mild – stretching of ligaments), grade II (moderate – sprain of ligaments) or grade III (severe – dislocation or complete tear).

Diagnosis

Diagnosis of Acromio-Clavicular (A-C) Joint Sprain is derived from the patient’s history. Chiropractors are trained to take a thorough medical history and perform an examination including neurological and orthopaedic tests to determine what the problem is and whether chiropractic care is appropriate. Imaging is only indicated in patients with signs of a complete tear, severe trauma, a positive neurological exam, presence of a “red flag” or if there is no improvement after a course of chiropractic treatment. [55,57].

Back-in-Action clinical comment

Grade III strains (dislocations/ complete tears) are likely to need a surgical intervention but may benefit from adjunctive chiropractic care.

Chiropractic assessment and treatment of Acromio-Clavicular (A-C) Joint Sprain is initially aimed at pain relief, gentle local soft tissue work and treatment of the surrounding structures as there is often increased loading in these areas. In the long-term optimising the strength and length of shoulder muscles and improving shoulder position are important.

In our experience treating the symptoms and underlying causes of Acromio-Clavicular (A-C) Joint Sprain benefits from a combination of treatment techniques to increase the probability of a good result.

Use of ice and rest for a few days in the painful stage can be beneficial.

Our approach also often incorporates spinal manipulation, mobilisation, muscle release techniques, cross friction techniques to tendons, cranial work, neck and shoulder exercises, referral for massage therapy, diet and nutritional advice, functional neurological exercises, breathing techniques, acupuncture, cryotherapy (heat and/or ice), postural improvements, foot orthotics, ergonomic advice and relaxation counselling. Modification of any work or sport related activities that aggravate the problem is also essential.

If there is a grade III dislocation or if there is no response to a course of chiropractic treatment, referral for surgical management should be considered.