How Are Ac Joint Issues Treated
In situations of acute AC joint injury due to traumathe treatment is conservative for the most part unless there is a severe injury with tear of multiple ligaments and separation of multiple ligaments.
Treatment initially for mild injury or sprain of the AC Joint and surrounding structures includes sling for discomfort as needed, anti-inflammatory medications and rest followed by Physical Therapy.
Most shoulder injuries can be treated with Orthobiologic / Cellular Therapies such as Platelet-Rich Plasma, Bone Marrow Concentrate, and Prolotherapy. Once structural stability is restored, neuromuscular re-education and scapular stabilization through closed chain exercise can reduce the risk of re-injury.
Platelet Rich Plasma has been used clinically to stimulate tissue repair and improve surgical outcomes since the 1990s for wound care, oral surgery, hair growth, and musculoskeletal repair. The normal, natural healing cascade that we experience after daily activity is initiated by bleeding from microscopic tissue tears, which activates platelets containing abundant healing proteins including growth factors and cytokines. These proteins direct and coordinate the disinfection, clean-up, and regeneration of injured and degenerative tissue.
Platelet Rich plasma and other solutions including Stem Cells from Bone Marrow can be used to treat many tendon/ ligament and musculoskeletal injuries to encourage the bodys own healing response.
What Are Acromioclavicular Joint Injuries
There are four ligaments that hold the two bones of the AC joint together. When an AC joint injury occurs, these ligaments are stressed. This stress results in some degree of joint separation. There are two types of injuries of the AC joint: traumatic and overuse injuries.
Traumatic AC joint injury. This type of injury occurs when the joint is disrupted. The ligaments that hold the two bones of the joint together get stretched too far. This is called a shoulder separation. It is different from a shoulder dislocation, which involves the ball-and-socket joint.
Traumatic AC joint injuries are most common in people who fall and land on the outside of the shoulder or hand. Examples include a:
- Football player who is tackled.
- Cyclist who crashes.
- Worker who falls off a ladder.
Traumatic AC joint injuries can range from a mild to severe grade. Grading is based on the amount of joint separation involved. Mild cases can be treated by a physical therapist. More severe cases may require surgery followed by physical therapy.
- Heavy weightlifting .
- Jobs that require physical work with the arms stretched over the head.
What Is Acromioclavicular Joint Pain
The acromioclavicular joint is located at the top of the shoulder. Acromioclavicular joint pain is often shortened to ACJ pain or sprain. It is when the joint between the clavicle and the acromion becomes inflamed. This causes pain and is often tender to touch.
Acromioclavicular joint pain can interfere with a persons normal daily activities. It can limit their ability to perform overhead sports such as tennis and exercises in the gym such as a shoulder or bench press. It is a common cause of shoulder pain and can affect people of all ages.
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Ac Joint Injuries: Causes And Treatments
by Valet Health | Jun 2, 2021 | Blog, chronic pain
An Acromioclavicular joint injury, also known as AC separation, is a common injury that occurs in physically active people.Great researchsuggests that AC injury accounts for over forty percent of all shoulder injuries. In addition, AC injuries may take the form of mild injuries and severe injuries. Mild injuries are not associated with any significant morbidity. On the other hand, severe injuries can affect your shoulder function and are often accompanied by severe pain.
That being said, here is a brief elucidation of what you need to know aboutAC injuries.
Is Shoulder Arthritis And Ac Joint Arthritis The Same
Shoulder arthritis and AC joint arthritis are two different conditions. In people who suffer from AC joint arthritis, the junction of the clavicle and acromion wears thin, leading to symptoms of pain, inflammation, and stiffness in the shoulder area. In those who have shoulder arthritis, the arm bone which is called the humerus, as well as its cartilage wear away at the socket of the shoulder joint. The treatment and potential complications associated with these two conditions also differ.
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Symptoms Of Ac Joint Shoulder Pain
The classic presentation of AC joint pain involves pain and swelling on the superior aspect of the shoulder following acute trauma.
Initially, symptoms are often generalized to the trapezius and entire shoulder region but become progressively more localized to the AC joint as acute swelling improves.
Symptoms may intensify with specific movements, including bench pressing, dips, or when the individual rolls onto the affected side at night.
Range of motion testing will be painful and limited, particularly in abduction .
For a review of self-assessment tests, watch this video:
Ac Joint Pain From Arthritis
- Arthritis of the AC jointcan occur over time gradually and cause pain due to loss of surface cartilage in the joint itself.
- Pain can be caused by activities at work or in sports reaching overhead or lifting weights.
- Symptoms include catching sensation and pain reaching overhead. There may be clicking, popping, grinding sensations with reaching overhead or shoulder movement.
- Often there is pain at night while sleeping on the affected side.
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How Is Ac Joint Arthritis Diagnosed
The majority of people who are 50 or older have some signs of osteoarthritis in their major joints. In a lot of cases, it can be seen on an X-ray even when there are no symptoms. So, when it comes to diagnosing AC joint arthritis, while tests like X-rays and MRIs can be helpful, they should just be part of the diagnostic process.
To make a proper diagnosis, the following tools are normally used:
How Is It Diagnosed
Physical therapists can diagnose an AC joint injury through a shoulder exam. Your physical therapist will conduct a full evaluation to find out the degree of your injury and identify all the factors that may contribute to it.
They will begin by interviewing you to learn about your health history. They may be helped by forms you fill out before your first session. The interview will become more specific to the condition of your shoulder. Your physical therapist may ask you questions such as:
- How did your injury occur?
- How have you taken care of the condition, such as seeing other health care providers? Have you had imaging or other tests and received their results?
- What are your current symptoms? How have they changed your typical day and activities?
- Do you have pain, and if so, what is the location and intensity of your pain? Does the pain vary during the day?
- Do you have trouble doing any activities? What activities are you unable to do?
This information allows the physical therapist to better understand what you are going through. It also helps determine the course of your physical exam.
The physical exam will vary depending on your interview. Most often it will begin with observing the region of your symptoms and any movements or positions that cause pain. Your physical therapist also may examine other areas of your body that may have changed due to problems with your shoulder function. They may:
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What Causes Acromioclavicular Joint Pain
There is research that suggests that lots of people develop acromioclavicular osteoarthritis as they age. Severe injury and also surgery can do damage to the acromioclavicular joint. This can eventually lead to acromioclavicular osteoarthritis, even though AC joint pain symptoms might not be evident for months or even years later.
Acromioclavicular joint injury is another cause. People who spend a lot of time lifting objects, whether at home or on the sports field can experience mini-traumas in their shoulder joints. They are more likely to develop acromioclavicular osteoarthritis.
A congenital defect or illness could be a factor. If you have poor bone alignment, this could increase shoulder separation risks and increase the likelihood of you developing osteoarthritis of the shoulder.
Sometimes it just happens from the normal wear and tear. Sometimes, it occurs from people who have suffered from a fall, like falling off a bicycle, or you have taken a fall from skiing.
If you go to the doctor, he will say you have AC joint pain symptoms, such as sprains or dislocation. There has been a separation between the bones of the clavicle and the bones of the acromion. You have swelling or burning in your shoulder area.
Other acromioclavicular joint pain causes can be bone spurs in the shoulder area, frozen shoulder, shoulder separation, tears of the rotator cuff tendons, and poor shoulder posture. Ouch!
Translation Into Practice: Practice Pearls/performance Improvement In Practice /changes In Clinical Practice Behaviors And Skills
While corticosteroid injections can be useful for pain relief following traumatic AC joint injuries, there may be a deleterious effect on natural healing and inflammatory response, however, most believe they are reasonable when done sparingly.1,19 Others suggest they may negatively alter perceptions of pain and worsen long-term outcomes.20 Careful consideration of risks and benefits is important prior to any procedure.
In degenerative ACJ disease, diagnostic and therapeutic joint injections are more widely accepted.2 Ultrasound guidance can improve the accuracy of these injections. Treatment should also include a therapy program to improve ROM while strengthening periscapular and RTC structures.2
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When Should I Call My Healthcare Provider
See your healthcare provider right away if you have injured your shoulder and think you might have a shoulder separation. Call your provider if your symptoms don’t get better after your injury. Get emergency care if:
- You cant move your arm at all
- You have numbness in your arm or hand
- The skin over the shoulder is deformed or punctured
- You have signs of poor circulation, such as a cool, pale hand
Patient & Family Education
Patients should actively participate in the rehabilitation process to guide progression through the various phases of rehabilitation. In athletes, it is important to educate the patient and coaching/athletic trainer staff regarding the risks and benefits of any local anesthetic or steroid injections requested for earlier return to play.17
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Acromioclavicular Joint Separation Symptoms
The symptoms of an AC separation vary, according to the severity of the condition. Symptoms can include:
- Pain at the top of the shoulder, especially when moving the arm overhead, or while sleeping on the injured shoulder
- The appearance of a bump on top of the shoulder blade
- Weakness or instability in the arm or shoulder
- Limited mobility
- The shoulder seems to hang lower than normal
- A popping sound when moving the joint
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Reversing The Course Of Shoulder Disability
Reverse total shoulder replacement surgery may be an option for patients with shoulder degeneration and debilitating shoulder problems. Johns Hopkins shoulder surgeon Dr. Uma Srikumaran explains how this technology can be used to treat people who are not candidates for normal total shoulder replacement.
What Is The Treatment For Ac Joint Separation
These can be very painful injuries and the initial treatment is to decrease the pain. This is best accomplished by immobilizing the arm in a sling, placing an ice pack to the shoulder for 20 to 30 minutes as often as every two hours and using pain medication. The pain is usually proportional to the severity of the separation.
As the pain starts to subside, it is important to begin moving the fingers, wrist and elbow to prevent stiffness. Next it is important to begin shoulder motion to prevent a stiff or “frozen” shoulder. When and how much to move the shoulder should be done at the direction of your physician, physical therapist or trainer. Usually as the pain is decreasing you will find you can move it more, and this will not damage or hinder the healing process. The length of time needed to regain full motion and function depends upon the severity or grade of the injury. A grade 1 takes 10 to 14 days, whereas a grade 3 takes six to eight weeks. A grade 2 takes somewhere in between.
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How Are Ac Joint Injuries Treated At Orthoneuro
In many instances, your OrthoNeuro Shoulder Specialist will begin with conservative treatment options to treat AC joint injuries.
These treatment options can include:
- Physical therapy
If the pain and other symptoms do not subside in the course of a few weeks, or the ligaments are severely damaged, your OrthoNeuro Specialist may recommend an arthroscopic surgical procedure to repair the damaged ligaments and restore stability to the shoulder.
Using our advanced minimally invasive techniques, there is very little surgical trauma and you are able to recover and return to normal activities shortly after surgery.
At Different Disease Stages
Rehabilitation of Grade I or II injuries:15
- Phase I: Ice, immobilization, pain control. Begin passive and active ROM with a focus on internal and external shoulder rotation. Advance when near 75% of baseline ROM, decreased pain and increased deltoid and trapezius strength.
- Phase 2: Rotational ROM with abduction and flexion. Increase strength training and advance as tolerates.
- Phase 3: Advanced strengthening movements, including press exercises. Phase 4: Progress to activity or sport specific exercises.
- Grade I: Immobilization is not always required given intact capsule but may be used briefly to decrease pain.
- Grade II: Pain is expected to be longer given ligamentous injury.
- Grade III: With AC and CC ligamentous disruption, some dynamic stability via the delto-trapezial fascia remains. Operative treatment is controversial.
- Grade IV, V, and VI: Operative management is generally recommended. Conservative management may be recommended for Grade III-IV injuries in elderly patients or poor surgical candidates.4
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What Is An Ac Joint Injury
Acromioclavicular joint injuries occur when the clavicle is forcefully dislocated from the acromion and is usually caused by a direct blow to the shoulder or falling on an outstretched arm.
There are varying degrees of severity in AC joint injuries and are classified into three categories.
- Type I: The AC ligament is slightly torn, but theres no damage to the other ligaments.
- Type II: A partial dislocation of the joint and complete tearing of the AC ligament with little or no damage to other ligaments.
- Type III: Complete separation of the joint. The AC ligament, other ligaments, and the joint capsule are torn. Displacement of the joint is visible on an exam.
Without the ligament support, the shoulder drops from the weight of the arm and the clavicle is pushed upward causing a noticeable bump on the top of the shoulder.
If you have an AC joint injury the common symptoms can include:
- A visible deformity at the top of the shoulder
- A cracking or popping sound when moving the shoulder
The Board Certified Orthopedic and Sports Medicine Specialists at OrthoNeuro have helped thousands of patients with AC joint injuries return to an active and healthy lifestyle using a variety of treatment options.
Causes Symptoms Treatment Options And Other Resources
Shoulder pain can be disabling. Simple chores like grabbing something from the overhead cabinet or putting on a sweater can be almost impossible at times. A common cause of shoulder pain found on MRI or diagnosed by your doctor is AC Joint impingement. What is the AC joint? And what does it mean for it to be impinged? Lets dig in.
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Christopher J Centeno Md
Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who
What Kind Of Physical Therapist Do I Need
All physical therapists are prepared through education and clinical experience to treat a variety of conditions or injuries. You may want to consider:
- A physical therapist who is experienced in treating people with orthopedic or musculoskeletal .
- A physical therapist who is a board-certified specialist or who has completed a residency in orthopedic or sports physical therapy. This physical therapist will have advanced knowledge, experience, and skills that apply to those who are physically active.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association. This tool can help you search for physical therapists with specific clinical expertise in your area.
General tips when you’re looking for a physical therapist :
- Get recommendations from family, friends, or other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists’ experience in helping patients with shoulder pain.
- Be prepared to describe your symptoms in as much detail as possible, and report activities and movements that make your symptoms worse.
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