Injury Types

Are AC Joint sprains serious?-Dr. Morse

Photographer: Roy K. Miller/Icon Sportswire

Currently both Tampa Bay Buccaneers QB Jameis Winston and Detroit Lions WR Golden Tate are dealing with a common football injury, a sprained AC joint. What does this mean? A sprained AC joint, also known as the acromioclavicular joint, is commonly referred to as a ‘separated shoulder.’ This is an injury where there is a sprain of the supporting ligaments (acromioclavicular and coraco-clavicular ligaments) of the AC joint. Typically, this injury occurs when striking another player with the point of the shoulder, or in Winston‘s case, when a player lands directly on the point of their shoulder, often while being tackled/sacked.

The initial presentation of an AC joint sprain reveals exquisite tenderness over the AC joint, which is in between the tip of your shoulder and your neck, just above where the clavicle is (see picture). X-rays are typically ordered to evaluate for a clavicle fracture, which Green Bay Packers Aaron Rodgers just suffered, and to it as well is to assess the degree of AC separation. Pulling down on the arm of a player with a possible AC joint sprain is an easy way to evaluate the joint, as it will widen the AC joint, causing pain.

Management of this condition typically focuses on control of the inflammation and pain with ice, rest, and a sling, often for about three weeks. Integrating the use of protection with padding, early restoration of range of motion, and the preservation of the shoulder strength are all-important as well. If conservative options are still failing to control the pain, an ultrasound-guided AC joint steroid injection can be considered.

To keep it simple, there are basically three types of AC joint sprains, grades 1, 2, and 3. Mild AC joint sprains (Grade 1) involve just a mild sprain of the AC joint capsule and AC ligament, normal x-rays, with a return to play of about 1 to 2 weeks.

Moderate sprains (Grade 2) involve rupture of the AC capsule as well as the ligaments. X-rays will show upward displacement of the collarbone/clavicle, but the C-C ligaments are normal. These take about 3 to 4 weeks to fully heal. Grade one and two AC joint sprains often only result in the patient wearing a sling.

High-grade AC sprains (Grade 3) often do not require surgery, but there is complete AC joint dislocation, and complete rupture of both the AC and C-C ligaments. Grade 3 AC joint sprains typically heal in about 6 weeks. Some athletes, especially at the elite level, may decide to surgically stabilize their joint to help speed up their return to play. About 30 to 50% of patients who suffer an AC joint sprain will have residual pain at the AC joint. Surprisingly, patients who undergo surgery have a higher rate of AC joint arthritis than those who to choose a more conservative route.

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