Treatment for AC joint injuries has evolved significantly over the past two decades. As before, Type I and II injuries are best treated without surgery. A sling is used early-on for comfort, and the shoulder is mobilized early and often to prevent stiffness. Pain typically subsides after a few weeks. Physical therapy can be helpful if stiffness or weakness are a problem.

Type IV and V injuries are typically treated surgically. These injuries cause a fair amount of dysfunction, even after the initial trauma heals, because the clavicle is stuck out of place. Surgery is best done in the first few weeks after the initial injury, because the clavicle can be difficult to position back into place once it settles into its new position. Also, you can take advantage of freshly healing ligaments if the injury is addressed in a reasonable amount of time.

Type III injuries are controversial. There is good evidence to show that, for most patients, type III injuries can result in a normally functioning shoulder if they are left alone, although the appearance will change somewhat because of the prominent clavicle “bump.” Some patients (somewhere between 20-40%) will develop chronic pain in the AC joint, or will develop such an unstable joint that the shoulder is not usable (for instance, significant painful popping/subluxation of the clavicle when the arm is lifted above shoulder level). For these patients, late surgery is a good option. There is good evidence to show that patients with Type III injuries who opt for late surgery have just as good an outcome as patients who have immediate surgery. For some elite level athletes, early surgery can make sense depending on the timing of their training or competition season, so they can avoid the potential of having to miss training or competition later.