Man, this has been the year of AC (acromioclavicular) joint injuries with Manly Giants AFL…… They have had everything from grade 1 – 5 across the various grades in the club.
Top of the table Manly Giants Premier 1 team have had two of their top players Lachlan Kilpatrick (killer) & Harry Kosh (Koshy) out of action for a number of weeks during the 2014 season due to ACJ injuries.
Lachlan had a grade 3 ACJ at the start of May and was able to return to play after 5 weeks on the sideline due to intensive physiotherapy and rehabilitation at North Curl Physio alongside an individualised gym programme designed by Marty (club physio) & Jimi MacDonald (PT) from Body language gym to enable Lachlan to maintain his fitness and use this time to work on other areas of strengthening to ensure Killer came back stronger & fitter.
Koshy unfortunately suffered a grade 5 ACJ and underwent surgery by Orthopaedic Shoulder specialist Dr Marcus Chia in the Middle of July which will have him out for the rest of the season. We wish him a speedy recovery and look forward to seeing him back in action for 2015 season.
It isn't just semi-pros and elite athletes at risk of ACJ injury.AC joint injuries represent nearly half of all sporting shoulder injuries. They usually occur as a result of a fall on the tip of the shoulder. Injury may damage the ligaments, muscles and cartilage within the joint.
Where is the Acromioclavicular (AC) Joint?
The AC joint is formed between the end of the collarbone (clavicle) and a specific part (acromion) of the shoulder blade (scapula). Most people can identify their AC joint by feeling the bony lump on top of their shoulder.
Most people think there are only have 3 types of grades similar to other ligaments of the body but in fact there are 6 grades of ACJ injury.
Think you've done an ACJ?
Symptoms of AC joint injury vary according to the severity of injury. This includes pain, swelling and deformity (lump on top of the shoulder). Commonly bruising and skin abrasions are seen. Shoulder movements are painful, particularly lifting the arm or bringing it across the body. North Curl Curl Physiotherapy uses the following grades for AC joint injury.
Grade 1: swelling and tenderness but no visible deformity, normal on x-rays;
Grade 2: slight widening of joint on x-rays;
Grade 3: complete dislocation of joint but with muscles still intact;
Grade 4: collarbone (clavicle) dislocated backwards;
Grade 5: muscles detached from end of collarbone (clavicle);
Grade 6: rare, clavicle dislocated downwards (inferiorly)
Physical examination helps to assess the severity of the injury and to rule out other concomitant injuries. Xrays are essential to diagnose and classify AC joint injuries. In some cases a CT or MRI scan may be needed.
Treating an ACJ injury
Initial treatment consists of controlling the pain and swelling with ice and simple analgesics. The shoulder should be rested in a simple sling. Most AC joint injuries can be treated without surgery. An early and graduated rehabilitation program is instituted once the shoulder pain has subsided. This is followed by strengthening and endurance. Contact sports and heavy lifting should be avoided for up to 2 to 3 months to allow for ligament healing depending on severity of injury.
Sports Physiotherapists such as those at NCCP who have worked with professional teams such as Brisbane Lions can strap the joint and organise specific padding to help reduce pain and reinjury on return to play.
On occasions player may require a corticosteroid (CSI) organised under US to reduce pain when clinically the ACJ has healed and is stable but remains very painful on direct contact preventing player from getting back in to action.
CSI are rarely recommended to speed up players return due basis that they may cover up symptoms and cause more damage but this remains one condition which it is generally acceptable in comparison to other joints such as knee to use a CSI a the last phase of recovery /healing process to enable players to return to contact sports
Where physiotherapy treatment alone cannot remedy an AC injury a referral to a Shoulder Specialist is required. The goal of surgery is to reduce the joint dislocation and stabilise the joint. We recommend orthopaedic surgeons who utilise a key-hole (arthroscopic) technique in order to avoid the large incisions necessary for open reconstructions and achieve a faster recovery.
Post-operatively the shoulder will be placed in a sling for comfort. Active and passive range of motion exercises (below shoulder level) are commenced under the supervision of your physiotherapist at North Curl Curl Physiotherapy.
Strengthening can be initiated by the physiotherapist once the surgeon is happy with signs of healing and based on clinical presentation and progress of the individual patient. Once full range of motion and strength are obtained, return to sports and manual labour is permitted.