Acromioclavicular (AC) Joint Sprain (Grades I-II) Protocol

An acromioclavicular (AC) joint sprain, commonly referred to as a shoulder separation, involves injury to the ligaments stabilizing the joint between the collarbone (clavicle) and the shoulder blade (acromion). Grades I and II are mild-to-moderate sprains that do not require surgical intervention. This non-operative rehabilitation protocol focuses on early stabilization, pain control, avoiding heavy lifting during the acute phase, and a progressive return to full strength and overhead activities.

Phase 1: Acute Phase & Early Stabilization (Weeks 0-2)

Goals:

• Control pain, localized swelling, and muscle guarding.
• Protect the healing acromioclavicular (AC) and coracoclavicular (CC) ligaments from excess tension.
• Maintain range of motion of the wrist, hand, and elbow.
• Initiate early active-assisted shoulder movements within pain-free limits.

Precautions & Restrictions:

• Wear the shoulder sling as needed for comfort, especially in public or when sleeping (typically 3-7 days for Grade I, 1-2 weeks for Grade II). Discontinue as pain subsides.
• Strictly avoid heavy lifting, carrying, pushing, or pulling.
• Avoid overhead reaching or lifting the arm above shoulder level.
• Limit horizontal adduction (cross-body movements) as this compresses and irritates the AC joint.
• Avoid letting the arm hang unsupported; support the elbow with a pillow when sitting.

Suggested Exercises:

• Pendulum exercises (Codman's) for gentle passive joint decompression.
• Active range of motion for the elbow, wrist, and hand to prevent stiffness.
• Scapular squeezes/retractions (avoiding shoulder shrugging/elevation).
• Sub-maximal isometric shoulder exercises (flexion, abduction, external rotation) performed in a neutral position, strictly avoiding pain.
• Active-assisted shoulder flexion (using a cane or pulley) up to 90 degrees, within pain-free range.

Criteria to Progress:

• Sufficient pain control and reduction of acute swelling.
• Tolerance of active-assisted range of motion up to 90 degrees of flexion without sharp pain.
• Ability to perform light daily tasks out of the sling without an increase in symptoms.

Phase 2: Subacute Phase & Range of Motion Restoration (Weeks 2-6)

Goals:

• Restore full active-assisted and active range of motion (AAROM and AROM) in all planes.
• Re-establish normal scapulohumeral rhythm and eliminate shoulder shrugging (hiking).
• Initiate light, progressive strengthening of the rotator cuff and scapular stabilizing muscles.

Precautions & Restrictions:

• No lifting of objects heavier than 5 lbs.
• Avoid sudden, jerky shoulder movements or heavy pushing/pulling.
• Continue to avoid painful cross-body reaching and weight-bearing through the upper extremity (e.g., push-ups or planks).

Suggested Exercises:

• Progressive active-assisted and active range of motion: cane exercises and wall slides in all directions as tolerated.
• Scapular clocks and gentle prone rows to strengthen periscapular stabilizers.
• Rotator cuff strengthening: gentle external and internal rotation using resistance bands with a towel roll under the arm.
• Serratus anterior punches (supine or wall punches) to support scapular stability.
• Postural training to correct forward shoulder position.

Criteria to Progress:

• Full, pain-free active range of motion of the shoulder without compensatory movements.
• No pain or tenderness with daily low-load functional tasks.
• Good baseline strength of the rotator cuff and periscapular muscles.

Phase 3: Progressive Strengthening & Functional Recovery (Weeks 6-12)

Goals:

• Normalize rotator cuff and scapular stabilizer strength.
• Enhance dynamic stability of the shoulder girdle and acromioclavicular joint.
• Safely progress to overhead lifting, resistance training, and sport-specific activities.

Precautions & Restrictions:

• Avoid rapid increases in weight or resistance during overhead lifting.
• Avoid exercises that place extreme joint-shearing force on the AC joint (e.g., deep dips, wide-grip bench press, or heavy military press).
• Monitor for any joint soreness or localized tenderness at the AC joint, adjusting activity if symptoms flare.

Suggested Exercises:

• Progressive resistance training: dumbbell lateral raises (starting below 90 degrees), forward raises, and neutral-grip shoulder press.
• Advanced scapular training: prone T's, Y's, and face pulls.
• Light closed-chain exercises: wall planks, incline push-ups, and quadruped rocking to build joint compression stability.
• Dynamic stability drills (e.g., ball toss, perturbations).
• Sport-specific or occupation-specific functional drills.

Criteria to Progress:

• Full, pain-free active range of motion in all planes.
• Symmetrical shoulder strength (at least 90% of the unaffected side).
• No localized pain over the AC joint during functional testing or lifting.
• Successful return to normal recreational and occupational activities.

These guidelines represent a standard rehabilitation protocol. Individual recovery rates vary significantly depending on the size of the repair, bone/tissue quality, and general patient health. Your surgeon may modify this protocol specifically for you.

Disclaimer: This protocol is for educational purposes and is not a substitute for professional medical advice. Always consult your surgeon or physical therapist before performing any exercises or modifying activity restrictions.