Symptoms range from mild tenderness felt over the joint after a ligament sprain to the intense pain of a complete separation. The shoulder blade and upper arm bone should move together with the correct timing. Grade II a tear in the AC ligament, and/or a sprain or slight tear in the coracoclavicular (CC) ligament. The diagnosis of a grade III AC joint separation. may be the only finding in type I injuries. Taken September 6, 1999. While higher grade dislocations (grade 4, grade 5, and grade 6) are more severe they only differ from a grade 3 by the severity and the direction of the displacement. A detailed look at my successful rehab protocol for a grade 3 ac joint (Acromioclavicular) separation. However, any direct blunt force can cause an AC joint separation if severe enough. The patient is provided analgesia and placed in a sling for comfort. Type 4. A grade 3 AC joint separation is a true dislocation of the AC joint. Grade 4 involves posterior displacement or displacement backward. A careful and precise x-ray evaluation is critical in diagnosing the correct ac joint separation grade. Grade 3: Complete AC joint separation more than one-half the depth of the AC joint; clavicle under skin. 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. I'm a 27yr old male, 210lbs. Diagnosis is made with bilateral focused shoulder radiographs to assess for AC and CC interval widening. I had a severe (grade 3) AC joint separation in 2017. Sling should be in place for 5-7 days when not performing exercises. Grade I- mild shoulder separation. They were telling me 6+ months before I could lift any weight after the type of surgery they did back then. Distal clavicle positioned posterior to acromion. Coraco-clavicular distance increased as compared to normal side with partial tear of coraco-clavicular ligaments. This is also called a sprain. X-rays show one-half separation of the AC joint, i.e. I go through the exercises I did, the timing of progress and the supporting strategies to ensure my early return to hard climbing. 3. Diagnosis: R / L Grade (1/2/3) AC Separation Frequency: 2-3 times per week for 6-12 weeks, therapy to start immediately after injury *VERY IMPORTANT: THERAPIST MUST OBSERVE ATHLETE DURING EXERCISES TO MAINTAIN SCAPULAR RETRACTION AT ALL TIMES DURING THERAPY* Weeks 0-3 Therapist to observe athlete during rehab for proper mechanics An acromioclavicular joint separation, or AC separation, is a very frequent injury among physically active people.In this injury the clavicle (collar bone) separates from the scapula (shoulder blade). Classification of AC Joint Separation - Rockwood Classification, 1990 4, 6 Type I o Mild sprain of the AC ligament o No disruption of AC or coracoclavicular ligaments (Grade II or III) with loss of normal contour of the shoulder due to sagging of the acromion indicates ligamentous disruption of the AC joint.1, 6 An AC Separation, also called a Shoulder Separation is a different injury then a Shoulder Dislocation. Acromioclavicular (AC) joint injuries account for nearly half of all shoulder injuries among athletes involved in contact sports [13].While most injuries can be managed non-operatively, high-grade separations may result in persistent pain or functional decline and require surgical intervention [49].Many surgical techniques have been described AC joint separation symptoms vary based on the extent of injury. I think the procedures now are better so I might choose differently now. In a grade II injury these ligaments are only stretched but not entirely torn. Many different procedures, not all off them work, some not very well, long recovery time and trading a scar for a bump. AC Separations are a relatively common cause of shoulder pain and deformity. Grade II Injury damage to the ligaments which reinforce the AC joint. Grade 3 AC joint separation is a complete separation of the joint where the AC ligament and CC ligaments are completely torn, as well as the joint capsule. Non-operative Acromioclavicular Joint Separation Phase I: Gradual ROM (Injury to 2 weeks) Ice encouraged for the first week at a minimum: should be used 3-4 times per day. Grades 4, 5 and 6 AC separations are extremely rare. normal: 5-8 mm (narrower in the elderly) greater than 2-4 mm asymmetry (compared to radiographs of the contralateral side) What You Need to KnowThe most common conditions of the acromioclavicular joint are arthritis, fractures and separations.Acromioclavicular joint wear and tear is common among weight lifters.Treatment for AC joint problems ranges from non-operative to surgical procedures depending on the type of injury. It is commonly caused by a fall directly on the "point" of the shoulder or a direct blow received in a contact sport. This will provide an anchor for the support strip to attach to. Grade 5 AC Separation A grade 5 AC Joint Separation occurs when the clavicle is severely displaced superiorly. If the distance is more than that it is a grade 5. Grade 3 injuries are more frequently treated conservatively, without surgery, but will require an even longer rest/healing period. Recommendations are 3: 2-4 weeks for Grade I injuries; 4-6 weeks for Grade II injuries; 6-12 weeks for Grade III injuries; Case conclusion. What is an AC joint separation? The most common cause of an AC joint separation is falling on the shoulder. As the shoulder strikes the ground, the force from the fall pushes the scapula down. Grade 3 rupture of both AC and CC or coracoclavicular ligaments which often results in an upward displacement of the clavicle bone. A grade 3 AC joint separation is a complete separation of the joint where the AC ligament and CC ligaments are completely torn, as well as the joint capsule. Features of acromioclavicular joint injury include 6: soft tissue swelling/stranding. First, apply two or three strips of 2.5cm zinc oxide tape over the top of the shoulder covering the AC joint. Due to normal appearing x-ray, you diagnose the patient with a Grade II AC joint separation (due to the clavicle mobility on exam). The patient was diagnosed with a right-sided incomplete grade III AC joint separation with associated soft tissue swelling, ecchymosis, and loss of AROM. An AC joint injury will either be a minor injury (grade 1 or grade 2), or a major injury (grade 3, grade 4, or grade 5). Minor injury (Grade 1 or 2) If the AC joint is sprained but not dislocated the x-ray will be normal or nearly normal. Acromioclavicular joint (ACJ) separations make up approximately 9% of all injuries to the shoulder girdle in sports medicine and orthopedic practices. Types of AC joint injuriesType I = the AC ligament is slightly torn, but there's no damage to the CC ligament is unharmed.Type II = the AC ligament is completely torn, and there's little or no tear to the CC ligament.Type III = both the AC and CC ligaments are completely torn. In this case, the collarbone separates from the end of the shoulder blade. Ortho said surgery was an option but recommended against it at the time. Exercises to restore the scapular rhythm are also important. Grade I Injury the least damage is done, and the AC joint still lines up. The initial symptoms are very severe pain, localized swelling and the notable presence of a bump on the shoulder. Type 5. However, any direct blunt force can cause an AC joint separation if severe enough. Grade 3: The most severe shoulder separation completely tears both your AC and CC ligaments and puts your shoulder joint noticeably out of position. Even the grade 3 injuries usually allow a return to full activity with few restrictions. Mild vertical separation (normal AC interval 5-8 mm) Type 3. A grade 3 AC joint separation is a true dislocation of the AC joint. The initial symptoms are very severe pain, localized swelling and the notable presence of a bump on the shoulder. This involves a sprain of the AC ligament that does not move the collarbone and looks normal on X-rays. The Traditional Grade III, Severe AC Joint injury would equal "Superior Dislocation of the AC Joint (>100% but <200% displacement of the We have a patient who had a diagnosis of "right shoulder separation, acromioclavicular joint grade II". Grade 3 AC Joint Separation: Physical Therapy Protocol Immediate intervention for grade 3 AC joint injury involves the same treatments as grade 1 and 2 joint separation. Most AC separations occur from a hard fall onto the point of your shoulder. Subcutaneous distal clavicle. CC distance >100% contralateral side. (Color version of figure is available online.) Grade 4 AC joint sprain. Currently with regard to the common subtypes of complete AC joint separation (grades 3, 4, and 5) there is One study found that surgery may actually be no better than conservative management, even for high-grade shoulder . Grade 3 AC joint sprain. Next pass a support strip of tape from the front of the shoulder, down the side of the arm applying tension to the tape. I recently separated my shoulder and I looked on youtube to see how other people coped with the injury. If the distance between the two bones is at least 25% increased relative to the normal side, but less than 100% (double the distance) then the injury is considered to be a grade 3. AC and CC disrupted. Twenty-eight major league baseball (MLB) orthopedic team physicians were surveyed to determine their definitive management of a grade III AC separation in the dominant arm of a professional baseball pitcher and their experience treating AC joint separations in starting pitchers and position players. In a grade 3 AC joint sprain, the ligaments holding the joint are completely torn, making your shoulder highly unstable. Scapular rhythm. Also grade 3, surgery was optional and I declined. Recovery from a Grade I AC separation usually takes 10 to 14 days, whereas a Grade III may take six to eight weeks. How to tape the AC joint. Feb 2008 full grade III separation. Grade 5. Allman et al described a 3 grade classification with Rockwood and Green expanding this to a 6 grade classification model (known as the Rockwood grades). Diagnosis. A grade 3 AC joint separation is a true dislocation of the AC joint. An acromioclavicular joint injury, otherwise known as a shoulder separation, is a traumatic injury to the acromioclavicular (AC) joint with disruption of the acromioclavicular ligaments and/or coracoclavicular (CC) ligaments. Doc says it is a grade III ac separation. Grade 3 AC Joint Separation Now when it starts getting tricky is when you have involvement of all three ligaments here, so you have a tear here, a tear here, and a tear here [pointing to the three ligaments surrounding the joint]. 3 GRADES OF SEPARATED SHOULDER. A grade 3 is the worst and a grade 1 is the least severe. There is considerable debate, however, about type III injuries. When the AC joint is separated, it means that the ligaments are torn and the collarbone no longer lines up with the acromion. What is a Grade 5 AC separation? The AC joint may also become swollen, the upper extremity often held in adduction with the acromion depressed, which may cause the clavicle to be elevated. If you have displacement, thats considered a Grade 3 separation or AC joint separation.