Minor injury to acromioclavicular joint (ACJ grade 1 to 2 injury) 

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Information for patients who do not need a follow up appointment

What is this information about?

This information is about minor injuries to your acromioclavicular joint (ACJ). The ACJ is the joint at the end of your collar bone. 

The part of your shoulder blade that meets the end of your collar bone (clavicle) is called the acromium. The joint where your acromium meets your clavicle is called your ACJ.  

This information tells you:

• How to look after yourself when you go home from hospital with a minor ACJ injury 
• What exercises you can do to help heal and strengthen your arm  
• What follow-up treatment you might have  
• Who to contact if you need further help and support  

What is a minor ACJ injury?

ACJ injuries (like many other injuries) are graded by how severe they are. A grade 1 or 2 ACJ injury is a minor injury and not severe.  

In a grade 1 or 2 ACJ injury: 

• You have sprained the ligament that supports your ACJ joint. Ligament is tough body tissue that connects bones together in a joint and helps to keep them in the right position. 
• The bones in your joint may have moved out of place a little or not at all.

How long is it likely to take for my injury to heal?

It usually takes from 3 to 6 weeks for a minor ACJ injury to heal, but you may get symptoms for 3 to 6 months. Once your injury has healed, it is usual to have a small, painless lump at the end of your collar bone. This should not affect your ability to do things.  

Will smoking or vaping slow down my healing?

Yes. Smoking slows healing so if you smoke or vape try to stop or cut down. This is most important in the first 2 weeks after your injury. If you would like help to stop smoking talk to your GP or visit  Quit smoking for further information.  

What should I do if I am in pain after my my ACJ minor injury?

If you are in pain, take your usual pain killers or pain killers given to you in the emergency department. Follow the dose instructions on the packet. If you are struggling with pain do speak to your GP or pharmacist.

When should I wear my sling?

Use your arm sling for up to 3 weeks to allow the soft tissues to settle. You do not need to wear it at night.  

What should I do if I am struggling with my sling?

When should I start exercising?

It is important to start gentle exercises straight away to prevent stiffness when you are doing exercises which are shown later in this information.  

Will I have further (follow up) appointments?

No. We do not usually follow up people with this type of injury. Please contact the Virtual Fracture Clinic for further advice if: 

• You are still experiencing a lot of pain and swelling 3 weeks after your injury. 
• You are unable to follow the advice and exercises in this information or notice pain other than at your shoulder 
• After 6 weeks, you struggling to move your injured shoulder as much as you were able to before your injury 
• You would like further information or support after I have read this information. 

What should I do from week 1 to week 2 after my injury?

• Use your sling to allow the soft tissues to settle.  
• Rest your arm for the first 24 to 72 hours (1 to 3 days). However, it is important to keep moving around and moving your fingers, wrist, and shoulder, so they do not get stiff.  Do this gently, without causing too much pain.  
• Apply cold packs (ice pack or frozen peas wrapped in a damp towel) to the sore area for up to 15 minutes every few hours. This can provide short-term pain relief.  

• Take your arm out of the sling to wash, dress and do your exercises. You do not have to wear your sling at night. You may find it more comfortable to sleep propped up on pillows. 
• Aim to practice all exercises five times a day. These exercises should not cause too much pain.  Do fewer if they are making your pain worse. 

Hand, wrist and elbow exercises

Finger and wrist bending and straightening: open and close your hand as shown 10 times. Then move your wrist up and down 10 times. 

After a few days, hold a soft ball or a ball of socks. Squeeze the ball as hard as possible without pain. Hold for 5 seconds and repeat 10 times.

Elbow Bending to Straighten: bend and straighten your elbow as far as you can without pain. You should not feel more than a mild to moderate stretch. You can use your other arm to help if you need to. Repeat 10 times if there is no increase in pain.  

Forearm Rotations: keep your elbow at your side and bent to 90 degrees. Slowly turn your palm up (supination) and down (pronation). You should not feel more than a mild to moderate stretch. You can use your other arm to help if you need to.  Repeat 10 times if there is no increase in pain.  

Posture Exercise:

Bring your shoulders back and gently squeeze your shoulder blades together. Hold for 30 seconds. Repeat 5 times.  

Shoulder pendulum exercises

Stand next to a firm surface. Support yourself with your un-injured arm and lean forwards. Let your injured arm relax and hang down to the ground.  

Gently swing your arm, making a small movement. Try to do this forward and backward, side to side and in small circles.   

Aim to do this for 1 to 2 minutes in total. This exercise can cause some discomfort when you first start to do it. This will usually ease off after you have repeated the exercise a few times. 

Swing your arm gently so is does not cause you too much discomfort. Remember keep your arm relaxed.  

What should I do from week 3 to week 5 after my injury?

• Continue using your arm sling for 3 weeks after your ACJ injury. 
• Stop using your arm sling at start of week 4 (22 days) after your injury. 
• Gradually return to light activities. 

• Start the exercises below 3 weeks after your injury. Try to do them 5 times a day. Repeat each exercise 10 times.

Exercises:

Supported arm elevation
Use your other hand to lift your injured arm up in front of you, as shown in these pictures.  

Supported arm rotation 

With your elbow touching the side of your body, bend your injured arm as shown below. Hold onto a stick, umbrella, or something similar. Then move your injured forearm outwards aways from your body. As you do this, keep your elbow bent and tucked into your side.  

Use your good arm to gently push the hand of your injured arm outwards. Remember to keep your elbow tucked in. If you do not have a stick, hold your injured arm at the wrist and guide it outwards with your good hand. 

What should I do from week 6 after my injury? 

Your ACJ minor injury should be healed at 6 weeks after your injury. 

Exercises: 

Arm elevation 

Lift your arm forwards in front of you. Try to raise the arm as high as you can. You do not need to push into pain. If this is too difficult, try the same movement with a bent elbow. 
 

Raising your arm out to the side 

With your palm facing forwards, move your arm out to the side in a big arc. Try to raise your arm as high as you can. If this is too difficult, try the same movement with a bent elbow. You do not need to raise your arm so high or for so long that it causes too much pain.

Arm rotation 

Start with your elbow bent by your side. Move your forearm out to the side, keeping your elbow bent and near your waist. 

When can I start driving?

You can return to driving when:  

• You are no longer using your arm sling    
• You can turn the steering wheel as much as you need to without it hurting  
• You can safely deal with all emergency situations without being in pain or hesitating. For example, you must be able to stop the car quickly and in full control and safely avoid obstacles  
• You are covered by your insurance company.  

How can I get a note for work?

Please contact the Virtual Fracture Clinic.   

How do I contact the Virtual Fracture Clinic?