How Is Arthritis Of The Ac Joint Treated
When the cartilage is gone from the joint, there is no way to replace it. As a result, one way to treat arthritis is to modify your activities so as to not aggravate the condition. This does not mean giving up activities entirely but it may mean doing certain ones less often or with less intensity. For example, weight lifters may bench press only three quarters of the way down instead of doing a full bench press or to exercise their pectoralis muscle , they may do a lift called a butterfly, which does not seem to irritate the joint as much as bench press.
Other ways to treat arthritis of the AC joint include the use of ice and medication. Application of ice to the joint decreases the pain and the inflammation at the joint. It is recommended that the more the joint hurts the more ice be used. Ice should be particularly applied after athletic activities or if the joint is very sore, ice should be applied daily or as often as every two hours. Ice should be applied for 20 to 30 minutes directly to the joint either using an ice bag or by massaging the joint with ice cubes. Since the joint is relatively small, ice massage can be very effective, and paper cups filled with water and placed in the freezer make great ice cones for massaging the joint.
Acromioclavicular Joint Sprains And Dislocations
In the world of sports and athletics many of us have had slips, falls and bumps and bruises. In contact sports specifically there are a few injuries that are more predominant than others and one of those injuries is called an Acromioclavicular or AC joint sprain or dislocation. In my role as a hockey trainer for several years I have seen many of these injuries and they happen in different ways with varying levels of severity.
An AC joint sprain or dislocation occurs most often when there is a fall or trauma to the outer portion the point of the shoulder. This area of the shoulder is where the clavicle meets the shoulder blade at the top outside corner and can often be felt rather easily. The injury itself occurs when you have a separation of the clavicle away from the shoulder blade. This means that there is an actual tear to the ligaments that support the AC joint. Depending on the amount of trauma the injury has different severities and is classified by using a grading system. Depending on the grades there are different methods of treatment.
Will I Be At Higher Risk Of Shoulder Pain In The Future
If you follow your physiotherapists guidelines for rehabilitation, you will have a very low risk of any shoulder pain in the future. There is some debate about whether having a grade lll injury managed without surgery can slightly increase your risk of arthritis of the joint, but this should be discussed individually with your surgeon/physiotherapist. The good thing here is there is actually a low correlation between arthritic joint changes and pain levels.
What Is Shoulder Separation
A shoulder separation injury occurs when trauma damages the ligaments around the acromioclavicular joint. Its where the collarbone meets the shoulder blade . If the injury is severe, part of the shoulder blade may separate from the collarbone. A shoulder separation is not the same as a dislocation. In a dislocation, your upper arm bone pulls out of the shoulder joint. Shoulder separations are common, especially in active young adults.
Your shoulder blade connects to your upper arm bone and to your collarbone with ligaments. The highest point of your shoulder blade is called the acromion. Two AC ligaments attach the acromion to your collarbone. This is the AC joint. Another ligament, the coracoclavicular ligament, connects part of your shoulder blade to your collarbone.
Injury may damage these ligaments around your joint. If the damage is severe, the collarbone and shoulder blade pull apart causing a shoulder separation. Your shoulder blade may move downward from the weight of your arm.
Healthcare providers rate injuries to the AC joint based on how severe they are. A type I injury is the most mild. A type VI injury is the most severe. In a type I injury, the AC ligaments are only partially torn, but the bones remain in place. In a type III injury, both the AC and CC completely tear. Your collarbone and shoulder blade are slightly out of line. With more severe injuries, the bones pull out of position even more. There may also be damage to other tissues around the area.
How Will An Ac Joint Injury Be Diagnosed
More often than not after a traumatic injury you will get an X-ray of your shoulder. AC joint injuries will be shown on the X-ray and the degree of the injury will be interpreted by a radiologist or orthopedic surgeon. The grades of AC joint injury are:
Grade l: Slight stretching of the ligaments, all fibres intact and joint capsule intact
Grade ll: Rupture of one ligament, increased stretch of other ligament and capsule intact
Grade lll: Total rupture of both ligaments and joint capsule
Grade lV: End of collarbone is shoved backwards into upper trapezius muscle
Grade V: More severe level of a grade ll, with disruption to fascia also
Grade Vl: The collarbone is shoved downwards towards your ribs
What Are Some Good Ac Joint Injury Exercises
AC joint exercises involve range of motion and strengthening activities as advised by Dr. Verma and his specialized team of physical therapy experts. Depending on the grade of AC joint separation or shoulder separation, exercises may begin with simple range of motion such as rotating the shoulder and working up to lifting the arm forward and to the side. Under the direction of Dr. Vermas team, patients can begin wand or stick exercises, holding a light-weight object and lifting the arm in various positions. Please see Dr. Vermas team before attempting AC joint injury exercises on your own, to assure proper healing of the shoulder separation.
How Does A Doctor Know My Child Has An Ac Joint Injury
Your child’s doctor may need a complete medical history in addition to a physical exam, which may include:
- X-rays: A diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
- Magnetic Resonance Imaging : A diagnostic procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body. This test is done to rule out any associated abnormalities of the spinal cord and nerves.
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What Causes Shoulder Separation
Different types of shoulder injuries can lead to shoulder separation. Often, the injury happens when you fall directly on the top of your shoulder, when your arm is close to your body. A direct blow to your shoulder, or falling onto an outstretched hand, can also cause the injury. Car accidents and sports injuries are potential causes.
Do All Injuries Require Surgery
If you do have an AC injury, it will be classified into one of the six grades to select the appropriate treatment.
If the AC injury is of the lower grades, often I or II, the treatment process doesnt require an operation.
Grades IV, V and VI will require an operation for effective treatment.
Treatment of a Grade III AC joint injury, where the joint has separated and subluxed slightly and is partially dislocated, is controversial, and is really decided on a case-by-case basis as to whether the injury should be operated on or not.
Some people advocate early treatment, some people advocate leaving it for a while.
For a Grade III injury, it is best to see an orthopaedic surgeon for their opinion.
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Who Should I Talk To About My Recovery Options
Dr. Rolf of Beacon Orthopaedics received extensive training in advanced arthroscopic techniques and world-class experience in complex shoulder reconstructive procedures for tendon transfers, shoulder replacement, and reverse shoulder replacement procedures. If you think you might have sustained an AC joint injury, schedule an appointment today to speak with Dr. Rolf about your options. His experience and passion for sports medicine will ensure that you return to your favorite activities stronger and better than ever.
What About Traumatic Ac Joint Injuries
Unfortunately, AC joint injuries are not preventable. Traumatic AC joint seperations are most common in contact athletes and cyclists.
This is when there is a blow to the outer end of the shoulder, the arm is across the front of the body and the shoulder gets pushed down while the clavicle stays up.
So in an AC joint seperation, your clavicle actually hasnt gone up, even though thats what it looks like. Instead, your whole shoulder has come down and forward.
For a rugby player, that type of injury would most commonly come from a shoulder charge or tackle.
For a cyclist, its when they are thrown over the handle bars and land on the back corner of their shoulder as they roll over, or if they are hit by a car and go up onto the bonnet.
Very occasionally it can be as a result of a defend-type injury, where you have put your hand out and the shoulder just gets physically pushed back, but thats very uncommon.
Other cases include multi-trauma injuries such as high falls and car accidents.
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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
Recovery And Rehabilitation After Arthroscopic Ac Joint Repair
All patients will be expected to wear a sling for numerous weeks to protect the arm and keep it immobile following surgery. Physical therapy focused on shoulder range of motion will begin shortly after AC joint repair or AC revision surgery. As the ligaments heal, a physical therapist will progressively strengthen the joint and discard the sling. Patients can expect a full recovery and return to sports activities in three to four months in many cases.
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What Are The Symptoms Of An Ac Joint Injury
An AC joint injury, also known as a separated shoulder, is an injury to the acromioclavicular joint. The symptoms include: Intense pain as soon as the injury occurs. Joint pain ranging from mild tenderness to intense, sharp pain felt primarily on the top of the shoulder. Bruising and swelling in the shoulder. Weakness and visible deformity.
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.
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What Happens After Surgery
After the procedure, you are usually kept in hospital for a night, and before leaving, a physiotherapist will see you and give you small, simple exercises to complete at home.
Your arm will also be in a sling for 4 to 6 weeks.
Approximately two weeks after the surgery the stiches will be removed, and at the end of the six weeks the rehabilitation will begin, including active movement exercises. This is when you start moving your shoulder using your own muscles.
After that, you will begin a strengthening exercise program that is outlined and directed by a physiotherapist.
Treatment Options For Ac Joint Injuries
Depending on the type of AC joint injury, treatments can range from conservative remedies to more invasive surgical options. Generally, unless an injury is one of the more severe types, Dr. Nickson recommends nonsurgical treatments, such as resting, applying ice, and taking anti-inflammatory medication.
If your AC joint injury is one of the more severe types, surgical options ranging from light trimming of the bones to complete reconstruction might be necessary. Whether you undergo surgery or more conservative treatment, physical therapy and rehabilitation can be fairly beneficial to your recovery.
If youve sustained an injury to your AC joint, it may be time to make an appointment at Next Step Orthopedics. Particularly if youre feeling lasting pain or discomfort, it could be an issue that requires surgical intervention.
As an orthopedic surgeon, Dr. Nickson is skilled in providing both conservative and surgical interventions for your shoulder injuries. Dont wait for the issue to get worse. Call or schedule an appointment online, right on our website, today.
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What Is The Recovery Time From An Ac Joint Repair
The typical recovery time for patients in good health is usually around 6 months after surgery. At this time, patients are allowed to return to sporting and regular activities. Initially, following surgery, patients are asked to wear a sling for several weeks to protect the healing AC joint. After the six weeks, full range of motion is quickly re-established with the help of physical therapy and special exercises. After the ligaments have healed, patients will be allowed to use strengthening exercises to restore normal function.
What You May Not Know About An Injury To The Ac Joint
If you have an injury to the AC joint or the acromioclavicular joint, theres damage in the top joint of your shoulder, where your shoulder blade attaches to your collarbone. These injuries can be from overuse or from trauma usually sustained in a fall or by athletes who are more likely to engage in activities involving collisions, such as football, hockey, and other high-impact sports.
An AC joint injury is most common in people under 35, and five times more common in males of this demographic. Regardless of the cause, Dr. Dominique Nickson and his team at Next Step Orthopedics provide expert treatment for shoulder injuries. Heres what you may not know about an injury to the AC joint.
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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.
Ac Joint Sprain Exercises & Rehabilitation
Rehabilitation exercises for an AC joint sprain or separation will depend on the severity of the injury. Exercises should begin only when the ligaments have healed, and you have no pain during normal daily activities.
The following guidelines are for information purposes. We recommend seeking professional advice.
Full Recovery After Ac Joint Surgery Takes 6 To 12 Months
The late phase aims are to restore full shoulder movement, optimize rotator cuff strength and scapular control and enhance shoulder power, strength and endurance.
Overall achievable targets include driving from 6-8 weeks, light lifting from 6 weeks , breast stroke from 6 weeks, freestyle from 3 months and no contact sports for 6 months.
When Can I Return To Work And Sports
If your work is sedentary, such as sitting at a desk writing and typing, you could expect to be back at work within 1 to 2 weeks.
However, if you are an overhead, manual worker, it will probably be closer to 3 to 4 months before you can return to active duties in your job.
Furthermore, for a contact athlete like a rugby player or basketball player, they wont be able to return to playing for at least 5 to 6 months.
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How Many Times Will I Need To See A Physiotherapist After An Ac Joint Injury
This will depend highly on how you are responding to treatment and recovering from your injury. After a grade l-ll injury, expect to see your physiotherapist 1-2 times per week in the first 4 weeks to help minimise your pain and get you moving as quickly as possible. As your injury settles and your rehab progresses, you can still expect to see your physiotherapist weekly as they manage your exercises and return to sport/activity plan. After you have returned to sport/activity, your physiotherapist will continue to work with you to make sure your return to activity/sport is sustainable. All up, it would not be unreasonable to see your physiotherapist 8-12 times over 10-12 weeks.
After surgery, how often you see your physiotherapist can change based on your surgeons guidelines. Some surgeons have different protocols and this can change your rehabilitation timelines slightly. After surgery, you will be in a sling for 2-6 weeks, and you can expect to see your physiotherapist 1-2 x per week in this time to help keep your shoulder moving and start your rehabilitation as early as the protocol allows. When out of the sling, you will be starting more intensive rehabilitation and this can be continued to be monitored 1-2 times per week. As with the grade l-ll injuries, your physiotherapist will continue to work with you even after you have returned to sport.