A rugby player lands heavily on the point of his shoulder. He’s ‘done’ his AC joint. Strap it up. Add some padding. Get him through the season. If the x-ray says it is a Grade V, perhaps he gets referred to a surgeon. Everyone else carries on, often wearing their new bump like a badge of honour around the changing room. After all, it’s only a little joint at the top of the shoulder, right? Sound familiar?
I’ve been there and done that. It was last century, but I’m not sure our thinking has evolved as much as it should have. Did it work? Sometimes. It often got the player back onto the field. But what happened to those people several years later?
I now work as a Specialist Shoulder Physiotherapist, and chronic AC joint instability is one of the more common conditions I see. These injuries may continue to grumble or become more troublesome years later, affecting heavy work, gym training, sport and sustained use of the arm. Many have already completed several rounds of typical shoulder rehabilitation (rotator cuff exercises, low rows, push-up plus etc) without much success. Often, the problem is not the AC joint itself, but the ongoing secondary scapular dysfunction caused by the original injury.
The unstable scapula: a clinical re-frame
Part of the problem is that we continue to view these injuries as a localised joint disruption. We call them AC joint injuries. We grade them according to an x-ray of the AC joint. We then tend to direct our treatment towards the painful area at the top of the shoulder. Guilty (there may even have been an ultrasound unit involved many years ago).
