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Acromioclavicular Joint Separations Grades I–III

A Review of the Literature and Development of Best Practice Guidelines

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Abstract

Acromioclavicular joint (ACJ) separation injuries are common injuries among sporting populations. ACJ separations are graded according to severity from grade I being a mild sprain to grade VI, which is severe dislocation with displacement. There is consensus in the literature that grade I–III ACJ separations are managed conservatively and grades IV–VI are managed surgically. Despite conservative care being recommended for lesser grades of injury, there is very little evidence in the literature as to what constitutes conservative care. Therefore, the purpose of this paper was, first, to review the relevant anatomy and kinematics of the ACJ and, second, to review the literature relating to current evidence of conservative management of ACJ injury. Using this data, a best practice guideline for conservative rehabilitation in grade I–III ACJ separations was developed. For the conservative management, a literature search was undertaken using the following databases in the Auckland University of Technology’selectronic library resources; MEDLINE, CINAHL, SPORTDiscus™ and the Cochrane Library. The following keywords or phrases were used: ‘acromioclavicular joint separations’, ‘injury’, ‘dislocations’, ‘rehabilitation’, ‘conservative care’, ‘physiotherapy’ and ‘exercise’.

A total of 24 articles was identified. There were no randomized controlled trials (RCTs) that investigated conservative treatment for grade I–III ACJ sprains. Therefore, a narrative review was formulated covering the anatomy and biomechanics of the ACJ, injury mechanisms and relevant literature reviewed covering rehabilitation principles. Conservative management of grade I–III ACJ separations is still the main recommendation following this review. A best practice guideline for managing grade I–III ACJ separations is presented to help guide clinicians until well constructed RCTs are carried out to improve the conservative management of ACJ injuries.

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Acknowledgements

This project was funded by a Sport and Recreation New Zealand (SPARC).— Prime Minister’s Scholarship, 2010

The authors would like to thank the High Performance Sport New Zealand (formerly New Zealand Academy of Sport) for their ongoing support for the time allowed completing the project, and Monique Baigent and Angela Cadogan for proof reading the article and for their feedback.

The authors have no conflicts of interest that are directly relevant to the content of this review.

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Authors and Affiliations

  1. Health and Rehabilitation Research Institute, School of Rehabilitation and Occupation Studies, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand

    Duncan Reid, Kate Polson & Louise Johnson

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  1. Duncan Reid
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  2. Kate Polson
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Correspondence to Duncan Reid.

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Reid, D., Polson, K. & Johnson, L. Acromioclavicular Joint Separations Grades I–III. Sports Med 42, 681–696 (2012). https://doi.org/10.1007/BF03262288

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