Related Pathologies and Etiology of Symptoms
Overuse Syndromes. Overuse syndromes of the AC joint are frequently arthritic or post-traumatic conditions. The causes may be from repeated stressful movement of the joint with the arm at waist level, such as with grinding, packing assembly, and construction work, or repeated diagonal extension, adduction, and internal rotation motions, as when spiking a volleyball or serving in tennis.

Subluxations or Dislocations. Subluxations or dislocations of either joint are usually caused by falling against the shoulder or against an outstretched arm. In the AC joint, the distal end of the clavicle displaces posteriorly and superiorly on the acromion; the ligaments supporting the AC joint may rupture. Clavicular fractures may result from the fall. After trauma and associated overstretching of the capsules and ligaments of either joint, hypermobility is usually permanent because there is no muscle support to restrict movement.

Hypomobility. Decreased clavicular mobility may occur with sustained faulty postures involving clavicular and scapular depression or retraction. Restricted mobility may contribute to a thoracic outlet syndrome (TOS) with a compromise of space for the neuromuscular bundle as it courses between the clavicle and first rib.

Common Impairments
• Pain localized to the involved joint or ligament

• Painful arc with shoulder elevation

• Pain with shoulder horizontal adduction or abduction

• Hypermobility in the joints if trauma or overuse is involved

• Hypomobility in the joints if sustained posture or immobility is involved

• Neurological or vascular symptoms if TOS is present

Common Functional Limitations/Disabilities
• Limited ability to sustain repeated loaded movements related to forward/backward motions of the arm, such as with grinding, packing, assembly, and construction work.

• Inability to reach overhead without pain.

• Inability to serve effectively at tennis or spike a volleyball.

Nonoperative Management of AC or SC Joint Strain or Hypermobility
• Rest the joint by putting the arm in a sling to support the weight of the arm.

• Cross-fiber massage to the capsule or ligaments.

• ROM to the shoulder and grade II traction and glides to the glenohumeral joint to prevent glenohumeral restriction.

• Instructions in self-application of cross-fiber massage if symptoms occur after excessive activity.

Nonoperative Management of AC or SC Joint Hypomobility
Joint mobilization techniques are used to increase joint mobility.

Acromioclavicular joint: anterior glide.

Sternoclavicular joint: anterior and inferior glides. Pull the clavicle upward for an anterior glide. Press caudalward with the curled fingers for an inferior glide.

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