Sprained AC Joint? 7 Things You Need To Know…

What to Do if You’ve Sprained Your Acromioclavicular Joint

By Coach E

sprained ac joint

Take a tumble during your game the other night? Hoping this shoulder pain will go away on its own? It’s possible you’ve got a sprained AC joint and if this is the case, here are the 7 things you need to know.

Got Shoulder Pain After a Fall or Hit?

Get checked into the boards during hockey practice the other night?

Maybe you’ve experienced this, or something similar.

You tried to brush it off, got back up, and finished the game.

But man, was your shoulder aching.

When you wake up the next morning, your shoulder is swollen and bruised.

sprained ac joint - shoulder pain

But the ache is different than it was last night – it’s more centralized, and you notice a specific spot of pain on the top of your shoulder.

You pop some Advil and head to work, still thinking you just bruised it up and the pain will go away in a couple of hours.

But every time you reach to grab something off the shelf above your desk, you get hit with a sharp pain in that same spot.

“What the hell did I do?” you think as you decide to stop reaching with that arm…

My friend, I think it’s safe to say that you sprained your AC joint.

What is an AC Joint Sprain?

The acromioclavicular (AC) joint is formed by your clavicle (collarbone) and the acromion, which is a bony process on the top of your scapula.

rained ac joint - shoulder anatomyThe joint is held together by several ligaments – the acromioclavicular ligament and the coracoclavicular ligaments – which provide stability to the joint [1].

An injury or sprain occurs when these ligaments become strained, overstretched or torn completely [2].

You may know a sprained AC joint by its more common name – a shoulder separation.

These injuries are classified depending on the severity of the problem and what ligaments are involved.sprained-ac-joint-separated-shoulderIn Grade I injuries, the most common type, your acromioclavicular ligament is strained or may even have a partial tear, leaving the joint mildly displaced from its normal positioning [3].

In Grade II injuries, your acromioclavicular ligament is torn completely, causing more significant shifting in the joint.

In Grade III injuries, both your acromioclavicular and your coracoclavicular ligaments are involved, causing a fully separated ac joint.

There are three additional classifications going all the way up to Grade VI and involving other parts of the shoulder.

But, these injuries are less common, usually caused by major trauma (like during a car accident), and usually need to be corrected by surgery [4], so we’ll be focusing on Grades I-III – the injuries athletes are more likely to face.

Signs of a Sprained AC Joint

The telltale sign of AC sprain is pain at the very top of your shoulder, right near where the clavicle connects to the acromion.

Sometimes the pain will start as general shoulder pain before it starts to focus in on that one spot [5].

There may even be a noticeable bump on the top of your shoulder, or there might be general swelling.

The pain usually intensifies when your arms are overhead or across the body, or when you try to lift something heavy [6].

What Causes AC Trouble?

Sprained AC joints are usually caused by a direct hit of some sort to the shoulder. This force might be generated by a fall directly on the shoulder or onto an outstretched hand [7].

A more indirect force can also cause the injury, like a fall on the elbow. This can force the head of the humerus up into the AC joint, causing strain [8]

sprained ac joint - american football

If you’ve been lucky enough to never injure your AC joint, you might read that and think, “Well damn, don’t be so clumsy!”

But there are plenty of ways this injury can come up.

A football play gone wrong, a crash during a cycling race, a fall on the ice during a hockey match, a snowboard wipeout… the list goes on and on.

It’s not too hard to see why these injuries are fairly common among athletes and active folks.

Testing for AC Joint Sprain

If you suspect you’ve got a AC joint injury, there are a couple of ways to confirm this.

It’s also important to differentiate between AC joint dysfunction and shoulder impingement.

Watch this video where I’ll guide you through 4 different tests that will help you identify the source of your shoulder pain:

And here are the AC joint specific tests…

Painful Arc Test

sprained ac joint painful arc test

The Painful Arc test is useful because where the pain occurs can tell you if you’ve got AC Joint injury or shoulder impingement.

Simply lift your arm up to the side as high up as you can until its overhead (don’t force it if it hurts) and see where the pain occurs.

If the pain is in the middle, you’re more likely suffering from shoulder impingement.

If the pain is at the top of the range with your arm overhead, AC joint injury is more likely.

Horizontal Adduction

sprained ac joint - horizontal adduction test

This is another easy one – just lift your arm up and across your body and if you’ve got a lot of pain at the end range, the AC joint is the likely culprit.

So, if you think you’ve sprained your AC joint, here’s what you need to know…

The 7 Things You Need to Know About Sprained AC Joints:

If you suspect you have an AC joint injury of any kind, there are several things you need to know to help you heal properly and get back in the game.

1. Go Get Some X-rays

This might not be what you want to hear, but you’ve got to get x-rays done if you suspect AC joint injury.

sprained ac joint xray

Image by www.radiopaedia.org

There’s really no way to know the extent of the injury and if any bones are fractured without doing so.

I know, a trip to the doctor isn’t what you want to do.

But trust me, if you let this injury go without treating it properly, it could mess you up for years.

The good news is, there’s absolutely no need for this injury to do that – you should be back in the gym quick, and without surgery in the vast majority of cases.

BUT, you’ve got to understand what you’re dealing with (which tendon is involved, how severe it is, etc.) so that you can treat it properly, or it WILL come back to bite you in the ass.

So, get yourself to the doc.

2. Avoid End Ranges

You need to avoid moving and stretching into the end of your ranges of motion.

I know there might be an urge to stretch for healing, thanks to years of programming by primary school gym teachers, but NOW IS NOT THE TIME.

Moving into those end ranges when you’re dealing with AC joint troubles can prevent healing and even cause further injury because you’ll be stretching already compromised ligaments.

It’s just like pulling on a rope that’s already starting to fray.

3. Avoid Pain

Beyond just avoiding those end ranges of motion, it’s crucial to avoid ANYTHING that causes pain.

If you feel pain being provoked, stop and back off whatever you’re doing. Take a mental note of what the aggravating motion was and avoid it. This is key to allowing your injured joint to heal.

For the First 7 days:

4. Use a Brace, Sling or Tape

In the acute period after your injury, you need to give your body some extra support.

You can use a variety of methods to do this – a brace, a sling or taping of the AC joint [9].

Whatever route you choose, the goal is to fix the joint in the correct position to allow proper healing to occur.

This is crucial in this initial period after the injury, so don’t skip it.

sprained ac joint - braceImage by www.sportsinjuryclinic.net

5. Ease Inflammation

You also need to ease any inflammation that might develop in this first week after your injury.

If you have inflammation, swelling or pain, apply ice in 15 minute bursts.

Supplementation with turmeric and fish oil is also a great way to ease inflammation in the body. [10, 11]

Check out PuraThrive if you’re looking for a good turmeric source.

After 7 days:

6. Introduce Pain-Free Movement

After about a week has passed, you’ll want to start introducing gentle movements.

These movements should be pain-free and easy – if you try a move that hurts, BACK OFF.

The shoulder pendulum is a great place to start – it gently encourages blood flow and circulation.

For this move, you just lean on something using your unaffected arm as support, simply letting the arm on the injured side hang down and relax. Start to move your body side to side or in a circle. This will allow the affected arm to move passively.

sprained ac joint - pendulumImage by www.health.harvard.edu

From here, you can begin adding on exercises but stick with small ranges of motion and low loads of weight or pressure on the shoulder.

7. GRADUALLY Ramp up the Movements

Now that you’ve introduced some simple and low-intensity movements, you can start to slowly ramp it up.

Begin to introduce movements that require a greater range of motion and greater loads.

First, focus on stability.

As you get stronger, start working towards greater mobility – you’ll need to work scapular retraction to avoid putting excessive stress on your AC joint.

Remember to be patient with yourself – you don’t want to re-injure your shoulder and have to start back at square one.

But, dedicated to healing and armed with the knowledge you just soaked up – you’ll be back out there in no time.

Happy shoulder healing, my friend.

About the Author

Eric Wong (aka Coach E) is the founder of Precision Movement and has a degree in Kinesiology from the University of Waterloo. He's been a coach since 2005 and spent his early career training combat athletes including multiple UFC fighters and professional boxers. He now dedicates himself to helping active people eliminate pain and improve mobility. He lives in Toronto (Go Leafs Go!) with his wife and two kids and drinks black coffee at work and IPAs at play. Click here to learn more about Eric.