Steroid injections for acromioclavicular Joint Sprain

 

An AC joint sprain occurs when the shoulder and arm are forced away from the collarbone and cause damage to the joint capsule and ligaments, which can lead to instability of the joint.

  • Direct trauma – falling directly onto your shoulder joint, usually with your arm across your body.
  • Indirect trauma – falling onto an outstretched hand.

These injuries are known as sprains/subluxations or dislocations depending on its severity and this will determine the treatment.

AC joint pain accounts for 9% of overall shoulder injuries (Mazzocca et al ,2007) and 43.5% of all shoulder injuries for those in their 20’s (Mall et al, 2013).

    Symptoms of AC joint pain

     

    • Localised pain at the top of the shoulder with tenderness at the AC joint
    • Pain will be worse when you move your arm across the midline of your body.
    • Pain will be worse when raising your arm out sideways (abduction) and overhead.
    • Pain lying on your side

    Anatomy

    The acromioclavicular joint (also known as the ACJ) is a small, stable joint which is formed by the junction of the lateral clavicle and acromion process of the scapula. It is secured by the joint capsule and ligaments. The joint is also dynamically stabilised by the trapezius and anterior deltoid muscle.

    While the clavicle and acromion do not move much in relation to one another, the AC joint allows for raising the arm over the head as well as moving the arm across the body and helping movements of the scapula. It also allows transmission of forces from the upper limb to the clavicle.

    Acromial apophysiolysis Anatomy

    Acromioclavicular joint sprain

    An AC joint sprain occurs when the shoulder and arm are forced away from the collarbone and cause damage to the joint capsule and ligaments, which can lead to instability of the joint.

    • Direct trauma – falling directly onto your shoulder joint, usually with your arm across your body.
    • Indirect trauma – falling onto an outstretched hand.

    These injuries are known as sprains/subluxations or dislocations depending on its severity and this will determine the treatment.

    How to diagnose

    One of our highly skilled physiotherapists will ask a series of questions and perform a physical examination to help develop a diagnosis. Here at Oxford Circus physiotherapy we can also use diagnostic ultrasound to check the grade of the injury and stability of the joint. Using the diagnostic ultrasound also allows the clinician to assess the AC joint dynamically throughout painful arm movements.

    Acromioclavicular joint sprain treatment Treatment

    In general, acromioclavicular joint pain can be well managed with conservative treatment and not require surgical intervention.

    Symptoms usually resolve with the following:

    • Wearing a sling for the first couple of days of the injury to allow pain to settle down. It is advised to avoid wearing the sling for longer than a week.
    • Keep the shoulder moving as much as pain allows.
    • A course of physiotherapy to restore range of movement, strength and function.
    • Over the counter anti-inflammatories and pain relief.
    • Short period of rest from aggravating factors – particularly lying on that shoulder and overhead activities. It is important to avoid aggravating activities for at least 6 weeks as returning to certain activities too soon can cause further injury.

    Physiotherapy may include:

    • Independent exercise program to strengthen the stabilising muscles of the AC joint and surrounding muscles.
    • Advice on appropriate load management and a gradual return to activity plan/
    • Manual techniques including soft  tissue release to provide relief and help restore full range of movement..
    • Ergonomic and postural advice.

    AC Joint Sprain Ultrasound guided corticosteroid injection

    If symptoms have not improved after 6 weeks of physiotherapy, or if the pain is affecting your sleep, stopping you from performing everyday activities such as getting dressed or is limiting you from performing your physiotherapy exercises you may want to consider an ultrasound guided steroid injection.

    Steroid injections use a small dose of corticosteroid (a strong anti-inflammatory drug) and are injected under ultrasound-guidance into the acromioclavicular joint. Current evidence found that injections performed under ultrasound guidance are more accurate and more effective at reducing pain and improving function than landmark guided injections (Daniels et al, 2018).

    If you would like more information or would like to book an appointment, please contact us on 020 3475 5767 or email reception@oxfordcircusphysio.co.uk

    References

    Daniels, E.W., Cole, D., Jacobs, B. and Phillips, S.F., 2018. Existing Evidence on Ultrasound-Guided Injections in Sports Medicine. Los Angeles, CA: SAGE Publications.

    Mall, N.A., Foley, E., Chalmers, P.N., Cole, B.J., Romeo, A.A. and Bach Jr, B.R., 2013. Degenerative joint disease of the acromioclavicular joint: a review. The American journal of sports medicine, 41(11), pp.2684-2692.

    Mazzocca, A.D., Arciero, R.A. and Bicos, J., 2007. Evaluation and treatment of acromioclavicular joint injuries. The American journal of sports medicine, 35(2), pp.316-329.