Anatomy: Image from Orthoinfo.aaos.org
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Injuries
Ac joint dysfunction is a result of a sprain, dislocation, fracture or osteoarthritis at this joint

Dislocation and sprain
The Ac joint is usually injured by a direct fall onto the top of the shoulder, cycling injuries, or associated with over head throwing (Javelin) athletes. The shoulder blade (scapula) is forced downwards and the clavicle (collarbone) appears prominent. The degree of injury at the joint is classified by the separation of the joint and damage to ligaments supporting it. A sprain suggests ligament injury whereas a dislocation refers to the clavicle moving upwards and backwards out of its normal alignment. The degree of this separation between the clavicle and acromion is graded on a 6 point scale, with grade 3-4 or higher requiring surgery.

The altered position of the clavicle, disrupts the normal rotation action of thr clavicle that is required to achieve end range forward flexion (overhead ROM). Pain will occur as a result of over stretched/ ruptured ligamemts (depending on the severity) and a stretched joint capsule. As a protective mechanism, pain tends to lead to altered postures which may comtribute to neck pain and altered muscles activity of muscles that attach to the clavicle; such as the pecs, trapezius and  sternocleidomastoid.

Fracture
The fracture may occur at the distal end of the clavicle following contact sports injuries, bicycle and car accidents.

Arthritis
The incidence of arthritis at this joint has been shown to be about 50% in MRI studies of elderly populations, however these people may be asymptomatic.
Just like any arthritis this refers to degeneration of the cartilage at the ends of the clavicle and acromion. Normal day-to-day activities that require repetitive arm motion can cause cartilage loss (primary osteoarthritis). In addition arthritis may be due to cartilage degeneration after an injury to the joint (post traumatic arthritis). Regardless of the cause, predominately the normally smooth cartilage, as well as the meniscus between the bones breakdown leading to pain, due to increased friction and thus creating an inflammatory response at the joint.

Signs and Symptoms
Arthritis
Pain and stiffness of the joint is a common symptoms as is catching and “clicking” at the shoulder. Usually, these complaints are worst with overhead activity or with positioning the arm across the body. These are both common positions of the arm- from daily activities such as brushing your hair or reaching your back pocket, putting a shirt on, to sports activities such as a golf swing.

Dislocation and sprain
Pain initially may be widespread throughout the shoulder until the acute phase resolves, following this stage the person will demonstrate specific tenderness at the site of the end of the clavicle. Swelling and depending on the the extent of the injury a step-deformity may be visible. This is an obvious lump where the joint has been disrupted (as in the case of a dislocation) and is seen in more severe injuries. Similar to arthhiritis the individual will report pain on moving the shoulder, especially with overhead activities and across your body motion.

Treatment
Acute injuries will respond to ice therapy, anti-inflammatory medications and a sling is often used.
Electrotherapy could be utilised to prevent the formation of scar tissue in the ligament and promote healing and decrease swelling.

Exercise therapy to restore strength and range of motion of both the neck and shoulder is vital. Strengthening exercises include lateral rotator work, as well as shoulder blade pinching exercises.

Taping can be applied to offload and realign the Ac joint.

Mobilisation of the Ac joint (clavicle) at painful ranges is also a common intervention used by physiotherapist to restore normal and pain free alignment.

If your not too sure whats causing your shoulder to hurt- book in to see a therapist for a shoulder assessment and treatment.

Another source for shoulder pain: Could it be the AC joint? is a post from: Musculoskeletal Consumer Review

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E 7: Pectoral stretch

Clasp hands behind your back then
draw your shoulders backward. Hold x 10 secs

7.1

E 8:

Flame stretch plus rib/ QL stretch

8.1

8.2

Add stretch  upwards through wrist to give length
through your side & help with end of swing 

8.3

E 9: Lancelot hip flexor stretch

Draw lower tummy in and tuck your bottom under.
Stretch your left then right hip flexor muscles with
a 10 second hold on each side. 

9.1

Lancelot hip flexor stretch with QL stretch added 

9.2

E 10: Buttock / piriformis stretch

Right leg crossed over left. Lean forward keeping
your back straight

10.1

10.2

E 11: Ribcage twist

Bring the right elbow to the left knee and extend the left arm towards the ceiling by moving from your torso.

Repeat 5 times and switch sides.

11.1

E 12: Squats

Stand as though addressing the ball, then hands onto hips.
Squat with bottom behind you x10

To get your hips moving and your bottom working

12.1

12.2

Photos and exercise selection was reprinted with permission from Dr Barbara Hungerford from Advanced Manual Therapy Associates.

Links:

http://www.amta.com.au

http://www.sydneyspineandpelvisphysio.com.au

Warm-up Routine For Golfers – Part II is a post from: Musculoskeletal Consumer Review

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Here are some recommended warm-up exercises for golfers designed by one of Australia’s respected physiotherapist, Dr Barbara Hungerford.

E(xercise) 1:

Wrist circles in club holding position

1.1

1.2

E 2:

2.1

2.2

2.3

2.4

E 3:

3.1

3.2

E 4:

Arms and hands move from in front of you, then out to the side

4.1

4.2

E 5:

Alternate arm stretch X 3 each side, then add chest rotation x 3

5.1

5.2

5.3

5.4

E 6:

Clasp fingers & turn inside out: stretch forearms & fingers

6.1

6.2

Photos and exercise selection was reprinted with permission from Dr Barbara Hungerford from Advanced Manual Therapy Associates.

Links:

http://www.amta.com.au

http://www.sydneyspineandpelvisphysio.com.au

Warm-up Routine For Golfers – Part I is a post from: Musculoskeletal Consumer Review

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