ACJ Dislocation: Understanding Acromioclavicular Joint Injuries

What is an ACJ Dislocation? 

An ACJ dislocation, or acromioclavicular joint dislocation, is an injury to the shoulder where the clavicle (collarbone) separates from the scapula (shoulder blade) at the acromioclavicular (AC) joint. The AC joint is at the top of the shoulder and is held together by ligaments. If these ligaments are torn or stretched, it can result in a dislocation or separation of the AC joint.

Types of ACJ Dislocations

ACJ dislocations are typically classified based on the severity of the injury:

• Type I: Mild sprain with no significant separation.
• Type II: Partial dislocation with some ligament damage.
• Type III: Complete dislocation with significant ligament tearing and a visible bump.
• Types IV-VI: More severe dislocations with displacement of the clavicle in different directions and involvement of surrounding tissues.

Prevalence of ACJ Dislocations

ACJ dislocations are relatively common, especially among individuals participating in activities that involve physical contact or the potential for falls. Here are some key points about their prevalence:

General Prevalence

• ACJ dislocations account for approximately 9-12% of all shoulder injuries.
• They are more commonly seen in young adults and athletes, particularly those involved in contact sports such as rugby, football, hockey, and wrestling.
• The injury is also prevalent in activites such as cycling or skiing that have a high risk of falls.

Sports and Activity-Related Prevalence

• Due to the nature of their activities, the incidence can be higher among athletes. For example, rugby players can suffer as high as 41% of all shoulder injuries.
• In cyclists, particularly those involved in road cycling and mountain biking, ACJ dislocations are also common due to falls from the bicycle.

Gender and Age Distribution

• Males are more frequently affected than females, which is likely due to higher participation rates in contact sports and high-risk activities.
• The typical age range for ACJ dislocations is between 20-40 years, correlating with peak participation in physically demanding sports and activities.

Overall, while ACJ dislocations are a common shoulder injury, their prevalence varies significantly based on activity level, sport, and demographic factors.

Symptoms and Causes of ACJ Dislocations 

The common causes of ACJ Dislocations are:

• Direct trauma: Often from a fall directly onto the shoulder, occurring with accidents or during contact sports.
• Indirect trauma: For example a fall on an outstretched hand, which transmits the force to the shoulder.

The common symptoms experienced with ACJ Dislocations are:

• Pain at the top of the shoulder
• Swelling and bruising
• A visible bump or deformity
• Limited shoulder movement
• Weakness in the arm

Risk Factors for ACJ Dislocations 

The risk factors for ACJ dislocations include a variety of intrinsic and extrinsic factors that can increase the likelihood of experiencing this type of shoulder injury. Here are the primary risk factors:

Intrinsic Factors

• Age and Gender:
  • Young adults (i.e., those in their 20s and 30s) are at higher risk.
  • Males more commonly injure their AC Joint than females due to higher participation rates in contact sports and physically demanding activities.
• Anatomical Variations:
  • Individuals with certain anatomical variations in the shoulder girdle may be predisposed to ACJ dislocations.
• Previous Injuries:
  • A history of shoulder injuries or previous ACJ dislocations can increase the risk of recurrent dislocations.

Extrinsic Factors

• Sports and Physical Activities:
  • Contact sports (e.g., rugby, football, hockey, wrestling) pose a high risk as there is potential for direct impacts to the shoulder.
  • Activities with a high risk of falls (e.g., cycling, skiing, snowboarding, skateboarding).
• Occupational Hazards:
  • Jobs that involve heavy lifting, repetitive overhead activities, or a high risk of falls (e.g., construction workers, painters).
• Traumatic Events:
  • Direct trauma to the shoulder; for example, a fall onto a hand when it is outstretched or a blow to the shoulder, can lead to ACJ dislocation.

Lifestyle Factors

• Risky Behaviors:

• Engaging in activities without proper protective gear or safety measures increases the risk.
• Participation in extreme sports or activities without adequate training or supervision.

Environmental Factors

• Unsafe Environments:

• Poorly maintained sports fields or playing surfaces can increase the risk of falls and injuries.
• Weather conditions that increase the likelihood of slipping or falling, such as icy or wet surfaces.

Understanding the risk factors allows individuals to take preventive measures, such as using protective gear, improving physical conditioning, and maintaining safe environments during sports and physical activities. Access Ortho can provide rapid care for acute shoulder injuries; seeking professional medical help early can help minimise risks. 

Potential Complications of ACJ Dislocations 

ACJ dislocations, if not properly treated, can lead to several complications that may affect shoulder function and overall quality of life. Here are some potential complications:

Acute Complications

• Persistent Pain:
• Ongoing pain in the shoulder, especially with movement or pressure, is a common complication.
• Shoulder Instability:
• Recurrent dislocations or a feeling of the shoulder being unstable can occur if the ligaments do not heal properly.

Long-Term Complications

• Chronic Pain and Dysfunction:
• Chronic pain and reduced shoulder function can result from improper healing or inadequate rehabilitation.
• Arthritis:
• Post-traumatic arthritis can develop in the AC joint, which may cause pain, stiffness, and reduced range of motion over time.
• Impingement Syndrome:
• Abnormal joint mechanics can lead to impingement of the rotator cuff tendons, causing pain and restricted movement.
• Shoulder Weakness:
• Persistent weakness in the shoulder muscles due to injury or inadequate rehabilitation.
• Deformity:
• A visible bump or deformity at the AC joint, known as a “step-off” deformity, can persist, especially in more severe dislocations (Type III and above).

Surgical Complications

If surgery is required to treat the ACJ dislocation, there are additional potential complications, such as:

• Infection:
• Post-surgical infections, although rare, can occur and may require further treatment.
• Hardware Issues:
• Complications related to surgical hardware, such as screws or plates, can occur, potentially requiring additional surgery for removal or adjustment.
• Nerve Damage:
• There is a risk of nerve injury during surgery, which may cause numbness, weakness, or other nerve-related symptoms.
• Scar Tissue Formation:
• Excessive scar tissue can develop, leading to stiffness and reduced mobility in the shoulder.

Psychological Impact

• Anxiety and Fear of Re-injury:
• Anxiety and fear of re-injury can affect participation in sports and physical activities.
• Impact on Quality of Life:
• Persistent pain and functional limitations can impact daily activities and overall quality of life.

Preventive measures, such as proper rehabilitation, adherence to physiotherapy protocols, and, when necessary, timely surgical intervention, can help mitigate these complications. In addition, seeking early medical advice will help reduce complications; Access Ortho can provide rapid appointments for acute shoulder injuries. 

Diagnosing ACJ Dislocations 

Diagnosing an ACJ dislocation typically involves a combination of a clinical examination and imaging studies. Here are the key steps and methods used in the diagnostic process:

Clinical Examination

• Patient History:
  • The medical practitioner will take a history of the injury, including how it occurred, the nature of the pain, and any previous shoulder injuries.
• Physical Examination:
  • Inspection: The shoulder will be inspected for visible deformities, swelling, bruising, or a prominent bump at the AC joint.
  • Palpation: The AC joint and surrounding areas will be palpated to assess tenderness and identify the location of pain.
  • Range of Motion: The provider will check the range of motion of the shoulder to determine any limitations or pain during movement.
  • Special Tests: Specific tests may be performed to assess the integrity of the AC joint, such as the cross-arm adduction test, where the patient crosses the affected arm over the chest, causing pain in the AC joint if it is injured.

Imaging Studies

• X-rays:
  • Standard X-rays of the shoulder are taken to confirm the diagnosis and classify the severity of the dislocation. Different views (e.g., AP view, Zanca view) may be used to get a clear picture of the AC joint.
  • X-rays can show the extent of displacement of the clavicle and help differentiate between various types of ACJ dislocations.
• Stress Views:
  • In some cases, stress views (X-rays taken with weights in the hands) may be used to assess AC joint stability and the extent of ligament damage.
• MRI:
  • MRI is not typically required for initial diagnosis but can be useful in evaluating associated soft tissue injuries and in chronic cases where other injuries are suspected.
• Ultrasound:
  • Ultrasound can be used to assess the AC joint and surrounding soft tissues, providing a dynamic assessment of the joint during movement.

Classification

The Rockwood classification system is often used to classify ACJ dislocations based on X-ray findings:

• Type I: Sprain of the AC ligaments without significant displacement.
• Type II: Partial dislocation with some displacement.
• Type III: Complete dislocation with significant displacement.
• Type IV: Displacement of the clavicle posteriorly into or through the trapezius muscle.
• Type V: Severe displacement with disruption of the deltoid and trapezius attachments.
• Type VI: Inferior displacement of the clavicle under the coracoid process.

Accurate diagnosis and classification are essential for determining the appropriate treatment plan and ensuring optimal recovery. Access Ortho has orthopaedic specialists trained in diagnosing and treating shoulder injuries such as ACJ dislocations.

Specific Considerations for ACJ Dislocations

When managing ACJ dislocations, the following specific considerations must be considered. Access Ortho are orthopaedic specialists with the expertise to manage these injuries.

Severity and Classification

• Rockwood Classification: The Rockwood classification system is widely used to determine the severity of ACJ dislocations, ranging from Type I (mild sprain) to Type VI (severe dislocation with significant displacement and soft tissue injury).
• Treatment Approach: The classification influences the treatment plan. Type I and II injuries are typically managed conservatively, while Type III can be managed conservatively or surgically, depending on the patient’s needs. Types IV to VI often require surgical intervention.

Patient Factors

• Age and Activity Level: Younger, active individuals, especially athletes, may benefit from more aggressive treatment to ensure a return to full function. Older or less active individuals might be managed more conservatively.
• Occupation: Manual labourers or those with physically demanding jobs may require a different treatment approach compared to individuals with sedentary lifestyles.

Mechanism of Injury

• Direct vs. Indirect Trauma: Understanding how the injury occurred helps in assessing the extent of damage and planning treatment. Direct trauma to the shoulder (e.g., from a fall or a direct blow) is a common cause.

Timing of Treatment

• Acute vs. Chronic: Acute injuries are typically treated differently than chronic conditions. Chronic ACJ dislocations might require more complex surgical interventions and longer rehabilitation.

Rehabilitation and Recovery

• Physiotherapy: Early physiotherapy is crucial for restoring range of motion, strength, and function. The rehabilitation protocol will vary depending on whether the injury is treated conservatively or surgically.
• Gradual Progression: Rehabilitation should be progressive, starting with range-of-motion exercises and followed by strengthening and functional training.
• Return to Activity: The return to sport or heavy labour timeline varies but typically ranges from a few weeks for mild injuries to several months for severe injuries or post-surgery.

Surgical Considerations

• Surgical Techniques: Various surgical techniques exist, including fixation with screws or plates, ligament reconstruction, and minimally invasive arthroscopic procedures. The surgeon will discuss the best option based on the type and severity of the dislocation.
• Post-Surgical Rehabilitation: After surgery, a structured rehabilitation program is essential for optimal recovery. It usually involves immobilisation initially, followed by progressive physiotherapy.

Potential Complications

• Chronic Pain and Instability: Even with proper treatment, some patients may experience chronic pain or instability.
• Arthritis: Post-traumatic arthritis can develop in the AC joint, leading to long-term discomfort and functional limitations.
• Surgical Complications: Potential complications from surgery include infection, hardware issues, nerve damage, and scar tissue formation.

Psychological Impact

• Fear of Re-injury: Psychological factors, such as anxiety and fear of re-injury, can affect rehabilitation and return to sports or work. Addressing these concerns is an important aspect of the overall treatment plan.
• Impact on Quality of Life: Chronic pain, functional limitations, and cosmetic deformity can affect a patient’s quality of life, requiring a comprehensive and holistic approach to treatment.

Preventive Measures

• Protective Gear: Using appropriate protective gear during sports and high-risk activities can help prevent ACJ dislocations.
• Strengthening and Conditioning: Regular strengthening and conditioning exercises can reduce the risk of dislocations and improve overall shoulder stability.

By considering these factors, the medical team can develop individualised treatment plans addressing the specific needs and circumstances of each patient with an ACJ dislocation. Access Ortho can arrange a rapid appointment for acute shoulder injuries. 

Managing and Treating ACJ Dislocations 

Managing and treating ACJ dislocations involves a range of approaches based on the severity of the injury, patient-specific factors, and the desired outcomes. Here’s a comprehensive overview:

Non-Surgical Management

Types I and II: These are generally mild to moderate injuries and can often be managed conservatively.

• Initial Treatment
  • Rest and Immobilisation: Use of a sling to immobilise the shoulder and allow healing.
  • Ice: Apply ice packs to minimise swelling and pain.
  • Pain Relief: Nonsteroidal anti-inflammatory drugs (NSAIDs) or analgesics to manage pain.
• Physiotherapy
  • Early Phase: Focus on gentle range of motion exercises to prevent stiffness.
  • Intermediate Phase: Gradual introduction of strengthening exercises for the shoulder girdle muscles.
  • Late Phase: Functional training and sport-specific drills to restore full function and facilitate return to activities.

Surgical Management

Types III, IV, V, and VI: More severe dislocations often require surgical intervention, particularly if there is significant displacement, instability, or if conservative management fails.

• Indications for Surgery
  • Persistent pain or functional limitations despite conservative treatment.
  • High-grade dislocations (Type IV-VI) with significant displacement.
  • Patients with high physical demands, such as athletes or manual labourers.
• Surgical Techniques
  • Open Reduction and Internal Fixation (ORIF): Repositioning the dislocated joint and securing it with screws, plates, or wires.
  • Ligament Reconstruction: Using grafts to reconstruct the damaged ligaments, providing stability to the joint.
  • Arthroscopic Surgery: A minimally invasive approach to repair the joint and ligaments, often resulting in quicker recovery times.
• Post-Surgical Rehabilitation
  • Immobilisation: Initial period of immobilisation to protect the surgical repair.
  • Physiotherapy: Progressive rehabilitation program, similar to non-surgical management but often longer and more intensive.
  • Gradual Return to Activity: Carefully monitored return to sports and activities, ensuring full recovery of strength and function.

Rehabilitation and Return to Activity

• Early Stage
  • Focus on pain management and gentle range of motion exercises.
  • Avoid heavy lifting or strenuous activities to prevent re-injury.
• Intermediate Stage
  • Increase intensity and variety of exercises, including strengthening around the rotator cuff, deltoid, and scapular stabilisers.
  • Functional training to improve coordination and stability.
• Late Stage
  • Advanced strengthening and endurance exercises.
  • Sport-specific drills and activities to ensure readiness for return to play or work.
• Monitoring and Adjustments
  • Regular follow-up appointments are important to check progress and adjust the rehabilitation program as needed.
  • Address any complications or setbacks promptly to ensure optimal recovery.

Preventive Measures and Long-Term Management

• Education
  • Educate patients on the need to follow rehabilitation protocols and avoid premature return to high-risk activities.
• Strengthening and Conditioning
  • Ongoing strengthening and conditioning exercises to maintain shoulder stability and prevent future injuries.
• Protective Gear
  • Use of appropriate protective gear during sports or high-risk activities to reduce the likelihood of re-injury.
• Lifestyle Modifications
  • Making adjustments to activities or work habits that may predispose to shoulder injuries, incorporating safe techniques and ergonomics.

Psychological Support

• Addressing Fear of Re-injury: Providing psychological support and education to help patients overcome fear and anxiety related to re-injury.
• Motivation and Encouragement: Ensuring patients stay motivated and engaged throughout the rehabilitation process.

Access Ortho will tailor the management and treatment approach to the individual needs of the patient, optimising outcomes and ensuring a successful recovery from ACJ dislocations.

Strategies to Reduce the Risk of ACJ Dislocations

Reducing the risk of ACJ dislocations involves a combination of preventive measures, proper training, and lifestyle adjustments. Here are some effective strategies:

Strengthening and Conditioning

• Regular Exercise:
  • Strength Training: Focus on strengthening the shoulder girdle muscles, including the rotator cuff, deltoids, and scapular stabilisers.
  • Core Stability: Enhancing core stability to support overall body mechanics and reduce stress on the shoulders.
• Flexibility and Mobility:
  • Incorporate stretching and mobility exercises to maintain shoulder joint flexibility.
• Balanced Workout Routine:
  • Ensure a balanced approach to training that includes strength, flexibility, and endurance exercises.

Proper Technique and Training

• Education and Training:

• Learn and practise proper techniques for sports and activities to avoid improper movements that can lead to injury.
• Engage in sport-specific training to develop skills that reduce the risk of falls and direct blows to the shoulder.
• Gradual Progression:
• It is important to gradually increase the intensity and length of activities to allow the body to adapt and strengthen over time.
• Use of Proper Equipment:
• Ensure that sports equipment is appropriately sized and maintained to provide adequate protection and support.

Protective Gear

• Shoulder Pads:
• Use appropriate protective gear, such as shoulder pads, during contact sports to absorb impact and reduce the risk of ACJ dislocations.
• Helmets and Other Protective Equipment:
• In sports like cycling or skiing, wearing helmets and other protective gear can prevent falls and shoulder injuries.

Safe Environment

• Ensure Safe Playing Conditions:

• Maintain playing surfaces to reduce the risk of falls and collisions.
• Ensure that the environment is free from hazards that could lead to accidents.
• Weather Considerations:
• Be mindful of weather conditions that increase the risk of slipping or falling, such as wet or icy surfaces.

Lifestyle Adjustments

• Avoid Risky Behaviours:
• Avoid engaging in high-risk activities without proper preparation and safety measures.
• Ergonomics:

• Implement ergonomic practices in the workplace to reduce repetitive stress and strain on the shoulders.
• Use proper lifting techniques to avoid shoulder injuries.

Monitoring and Maintenance

• Regular Check-ups:
• Regularly assess shoulder health, especially for individuals with a history of shoulder injuries or those engaged in high-risk activities.
• Early Intervention:
• Address any signs of shoulder discomfort or weakness early to prevent worsening of the condition.

Psychological Preparation

• Mental Conditioning:
• Engage in mental conditioning and visualisation techniques to enhance focus and reduce anxiety, which can contribute to safer movements.
• Confidence Building:
• Build confidence through consistent training and skill development to reduce the likelihood of hesitation or improper technique during activities.

By incorporating these strategies, individuals can significantly reduce the risk of ACJ dislocations and maintain shoulder health and function.

Outlook and Prognosis for ACJ Dislocations 

The outlook and prognosis for ACJ dislocations vary depending on the severity of the dislocation, the treatment approach, and the individual’s overall health and activity level. Here’s an overview of what to expect:

Acute Recovery

• Initial Healing:

• Type I and II Dislocations: Typically have a good prognosis with conservative management. Most individuals experience a significant decrease in pain and restoration of function within a few weeks to a couple of months.
• Type III Dislocations: Can have a variable prognosis. Conservative management may lead to good outcomes, but some individuals might experience persistent symptoms and may benefit from surgical intervention.
• Pain and Function:

• Pain Reduction: Pain usually decreases as the inflammation subsides and healing progresses.
• Restoration of Function: Proper rehabilitation can restore full range of motion and strength, although the timeline varies.

Long-Term Prognosis

• Chronic Symptoms:

• Type I and II: Most people recover fully and return to normal activities without chronic symptoms.
• Type III: There can be a higher risk of residual symptoms, such as pain or discomfort, especially if conservative management was used.
• Types IV-VI: Often associated with a higher risk of long-term issues, including chronic pain, shoulder instability, or arthritis.
• Arthritis:
• Post-traumatic arthritis is a potential long-term complication, especially for severe dislocations (Types IV-VI). This may develop over several years and can cause persistent pain and stiffness.
• Functional Outcomes:

• Full Recovery: Many individuals achieve full recovery and return to pre-injury levels of activity, especially with appropriate treatment and rehabilitation.
• Residual Limitations: Some individuals may experience ongoing limitations in shoulder function or strength, particularly if the injury was severe or if there were complications during recovery.
• Return to Activity:

• Type I and II: Most people can return to their normal activities or sports within a few weeks to a few months.
• Type III and Higher: The return to high-impact sports or activities may take longer and might require careful management and possibly surgical intervention.

Factors Influencing Prognosis

• Severity of Injury: More severe dislocations generally have a more complex recovery process and may lead to a higher likelihood of long-term complications.
• Treatment Approach: Surgical management typically has a longer recovery period but can be beneficial in preventing long-term issues in severe cases. Conservative management may be effective for less severe injuries but can sometimes result in residual symptoms.
• Adherence to Rehabilitation: Adhering to a rehabilitation program is crucial for optimal recovery. Proper physiotherapy helps in regaining strength and function and can reduce the risk of long-term problems.

Psychological Impact

• Emotional and Psychological Recovery: Some individuals may experience anxiety or fear related to re-injury, which can affect their overall recovery and return to activities. Psychological support and encouragement can be beneficial.

In summary, the prognosis for ACJ dislocations is generally favourable with appropriate treatment, especially for less severe injuries. Severe cases may require more intensive management and can have a higher risk of long-term issues, but with proper care and rehabilitation, many individuals achieve satisfactory outcomes. Contact Access Ortho for an urgent appointment if you have sustained an ACJ Dislocation or other shoulder injury. 

What to Expect After an ACJ Dislocation, including Recovery Time for ACJ Dislocations 

What to Expect After an ACJ Dislocation

Immediate Post-Injury Phase

• Pain and Swelling:

• Acute Pain: Significant pain is common immediately following the injury. Pain management typically involves rest, ice application, and analgesics.
• Swelling: The area around the AC joint will likely swell. Ice and elevation can help reduce swelling.
• Immobilisation:
• Sling Use: A sling may be used to immobilise the shoulder and provide support, reducing pain and preventing further injury.
• Initial Diagnosis and Treatment:
• Medical Evaluation: A healthcare provider will assess the injury using physical examination and imaging studies (e.g., X-rays) to determine the severity of the dislocation.

Recovery Timeline

The recovery time for ACJ dislocations varies depending on the injury and the treatment approach:

• Type I Dislocations:

• Recovery Time: Typically 1-2 weeks.
• Expectations: Full recovery is usually achievable with conservative management, including rest, ice, and physiotherapy.
• Type II Dislocations:

• Recovery Time: Approximately 4-6 weeks.
• Expectations: Similar to Type I, recovery usually involves conservative management with physiotherapy to regain strength and range of motion.
• Type III Dislocations:

• Recovery Time: Can range from 6-12 weeks.
• Expectations: Some individuals may manage conservatively, but persistent pain or functional limitations might necessitate surgical intervention. Post-surgical recovery can extend to several months.
• Types IV-VI Dislocations:

• Recovery Time: Typically 3-6 months or longer.
• Expectations: These types usually require surgical intervention. Recovery involves an initial period of immobilisation, followed by a structured rehabilitation program to restore shoulder function and strength.

Rehabilitation and Return to Activity

• Early Rehabilitation:

• Range of Motion: Gentle range of movement exercises start as soon as pain allows to prevent stiffness.
• Strengthening: Gradual introduction of strengthening exercises as healing progresses.
• Intermediate Rehabilitation:

• Functional Exercises: Incorporate exercises that mimic daily activities and sports-specific movements to prepare for a return to normal function.
• Coordination and Stability: Focus on improving shoulder stability and coordination.
• Late Rehabilitation:

• Advanced Strengthening: Progress to more intense strengthening and endurance exercises.
• Sport-Specific Training: If applicable, gradually reintroduce sport-specific drills and activities.
• Return to Full Activity:

• Type I and II: Return to normal activities or sports within a few weeks to a few months.
• Type III and Higher: Longer recovery periods with careful monitoring. Return to high-impact activities may take several months and depends on individual progress and rehabilitation.

Long-Term Expectations

• Full Recovery:

• Type I and II: Most people recover fully and resume normal activities without ongoing issues.
• Type III and Higher: There may be residual symptoms or limitations, especially if the injury was severe or if there were complications during recovery.
• Chronic Issues:

• Post-Traumatic Arthritis: There is a risk of developing arthritis in the AC joint, particularly with severe dislocations.
• Shoulder Instability or Pain: Some individuals might experience chronic instability or pain requiring ongoing management.

Psychological and Emotional Considerations

• Fear of Re-injury: Addressing any fear or anxiety about re-injury through support and reassurance can be an important part of recovery.
• Motivation: Maintaining motivation throughout rehabilitation is critical to optimal recovery.

By following appropriate treatment and rehabilitation protocols, most individuals can expect to recover from an ACJ dislocation and return to their pre-injury levels of function and activity. The medical team at Access Ortho will discuss your rehabilitation plan and return to activity. 

When to Seek Medical Attention for a Suspected ACJ Dislocation 

It’s important to seek medical attention if you suspect an ACJ dislocation to ensure proper diagnosis and treatment. Here are key signs and symptoms that warrant a visit to a healthcare provider:

Immediate or Severe Symptoms

• Severe Pain:
• Intense pain in the shoulder, especially if it is sharp, throbbing, or persistent, which does not improve with rest and over-the-counter pain medication.
• Visible Deformity:
• A noticeable bump or protrusion on the shoulder, particularly at the AC joint, which may indicate a dislocation.
• Swelling and Bruising:
• Significant swelling and bruising around the shoulder or collarbone area.
• Inability to Move the Shoulder:
• Difficulty or inability to move the shoulder or arm, especially if accompanied by severe pain.
• Numbness or Tingling:
• If numbness, tingling, or weakness develop in the arm or hand, this could suggest nerve involvement.

Symptoms Following a Trauma

• Direct Trauma to the Shoulder:
• If you have experienced a direct blow or fall onto the shoulder, especially during sports or high-impact activities, it is important to get assessed.
• Worsening Symptoms:
• If symptoms such as pain, swelling, and inability to move the shoulder worsen over time.

Concerns About Complications

• Persistent Pain:
• Ongoing pain despite rest and initial management, which may indicate an incomplete or severe dislocation.
• Functional Limitations:
• Continued difficulty with shoulder function or range of motion after the initial injury period.
• Signs of Infection (if surgical intervention was performed):
• Redness, warmth, or increased swelling around the surgical site, along with fever or drainage, could indicate an infection.

General Recommendations

• Initial Evaluation:
• It is advisable to see a healthcare provider as soon as possible after an injury to the shoulder to determine the extent of the damage and receive appropriate care.
• Emergency Situations:
• Seek immediate medical attention if you experience severe pain, a significant visible deformity, or signs of possible complications, such as severe swelling or numbness.
• Follow-Up Care:
• Even if initial symptoms seem manageable, it is important to attend follow-up appointments with the medical team to ensure healing occurs with no complications and to receive a structured rehabilitation plan.

Timely medical evaluation is crucial for diagnosing the severity of an ACJ dislocation, determining the appropriate treatment, and preventing potential complications. Access Ortho offers rapid appointments to ensure you get expert advice without waiting weeks for an appointment. 

Frequently Asked Questions About ACJ Dislocations 

What’s the difference between an ACJ dislocation and a shoulder separation?

The difference between an ACJ dislocation and shoulder seperation are as follows:

• ACJ Dislocation: Refers specifically to an injury where the acromioclavicular (AC) joint (this is where the collarbone meets the shoulder blade) is displaced.
• Shoulder Separation: Often used interchangeably with ACJ dislocation. It describes the same injury, where the separation occurs at the AC joint. The term “shoulder separation” might be more commonly used in some regions or contexts.

How is an ACJ dislocation graded?

ACJ dislocations are graded based on the following:

• Grade I: Mild sprain of the AC joint ligaments without significant displacement.
• Grade II: Partial tear of the AC ligament with a slight displacement of the clavicle.
• Grade III: Complete tear of both the AC and coracoclavicular (CC) ligaments, with significant displacement of the clavicle.
• Grade IV: Complete tear with posterior displacement of the clavicle into or through the trapezius muscle.
• Grade V: Complete tear with severe displacement and significant disruption of the shoulder girdle.
• Grade VI: Severe dislocation with the clavicle displaced inferiorly, often beneath the coracoid process.

Can an ACJ dislocation heal without surgery?

Yes, many ACJ dislocations, especially Grades I and II, can heal without surgery. Conservative treatment typically involves rest, ice, immobilisation, and physiotherapy. However, more severe cases (Grades III and above) may require surgical intervention depending on symptoms, functional demands, and response to conservative management.

What exercises can help rehabilitate an ACJ dislocation?

It is important to include the following in an ACJ dislocation rehabilitation plan:

• Range of Motion Exercises: Gentle movements to regain shoulder flexibility, such as pendulum swings and wall climbs.
• Strengthening Exercises: Focus on exerices for the rotator cuff and scapular stabilisers, including external rotations, scapular squeezes, and resistance band exercises.
• Functional Exercises: Gradual introduction of activities that mimic daily tasks or sports, as advised by a physiotherapist.

How long does it take to recover from an ACJ dislocation?

Recovery following an ACJ dislocation depends on the grade of injury and if surgery is required:

• Grade I and II: Typically 4-6 weeks for recovery with conservative treatment.
• Grade III: 6-12 weeks, with recovery potentially extended if surgery is required.
• Grade IV-VI: Recovery can take 3-6 months or longer, especially if surgical intervention is needed.

Will an ACJ dislocation affect my shoulder mobility in the long term?

While many people recover full mobility after an ACJ dislocation, some may experience ongoing stiffness, discomfort, or limited range of motion, particularly with more severe dislocations or if complications arise. Rehabilitation plays a key role in maximising recovery and maintaining mobility.

Are ACJ dislocations common in contact sports?

Yes, ACJ dislocations are relatively common in contact sports such as football, rugby, hockey, and martial arts due to the risk of falls and collisions that impact the shoulder area.

Can an ACJ dislocation recur after treatment?

Yes, particularly if the initial dislocation was severe or if rehabilitation was not completed properly. Individuals returning to high-risk activities or sports without adequate recovery may be at risk of recurrence.

What’s the best way to sleep with an ACJ dislocation?

It’s usually recommended to sleep on your back or on the uninjured side to avoid direct pressure on the affected shoulder. Using a supportive pillow to maintain a comfortable position can help.

How soon can I return to work after an ACJ dislocation?

Return to work following an ACJ dislocation depends on the type of work you do. For desk or sedentary jobs, you may return to work within a few days to a week, depending on pain and comfort levels. For manual or physically demanding jobs, recovery and return to work may take longer, typically 6-12 weeks or more, depending on the severity of the injury and the type of work. It’s important to consult with your medical team to determine an appropriate return-to-work timeline.