Neck & Shoulder

What It Is

The acromioclavicular joint is one of the joints that make up the shoulder complex. It is formed by the top part of the shoulder blade (acromion) and the collar bone (clavicle). Ligaments are soft tissue structures that support the acromioclavicular joint. The acromioclavicular (AC) ligaments surround the joint itself, and the coracoclavicular (CC) ligaments hold the collar bone down by attaching its underside to a bony bump of the shoulder blade (coracoid process) (American Academy of Orthopaedic Surgeons, n.d.).

Acromioclavicular separation occurs when trauma leads to disruption of the junction between the collar bone and the shoulder blade. The injury often occurs in people who play contact sports (Nolte et al., 2020). The most common cause is a fall directly onto the tip of the shoulder, although a fall on an outstretched arm can also cause it. The shoulder blade gets pushed downwards while the collar bone stays where it is, so the ligaments are stretched or torn (American Academy of Orthopaedic Surgeons, n.d.; Nolte et al., 2020).

The injury is graded I to VI (American Academy of Orthopaedic Surgeons, n.d.)

Grade I: a sprain of the AC ligaments; the collar bone does not move out of place.

Grade II: the AC ligaments are torn and the CC ligaments are sprained or slightly torn; the collar bone is slightly out of line, with a small bump.

Grade III: both the AC and CC ligaments are completely torn and the joint is noticeably out of position (so the collar bone now sits a lot higher than the acromion), with a larger bump.

Grade IV: the AC and CC ligaments are torn and the collar bone is pushed backwards.

Grade V: a more severe version of grade III, where the collar bone sits very much higher than normal; the attachments of the deltoid and trapezius muscles are also stripped away (Nolte et al., 2020).

Grade VI: a rare injury where the collar bone is pushed downwards.

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Symptoms

How It Feels

Signs & Symptoms

Pain (varies from mild tenderness to intense pain according to the degree of separation)
Swelling
Bruising
Noticeable bump on the shoulder in more severe separations

Treatment

Self-Care & Treatment

How to Manage

Whether or not you have surgery, rehabilitation is needed to restore movement, strength and flexibility in the shoulder (American Academy of Orthopaedic Surgeons, n.d.). I can help with this, with hands-on work and exercises for your shoulder, working within what your doctor or surgeon has cleared. See the My Approach tab for how I work.

Sling: a sling can help with comfort while the injury settles. For a minor (grade I to II) injury, NHS guidance is to use it for up to 3 weeks, coming out of it gradually as the pain improves (University Hospitals Sussex NHS Foundation Trust, 2026; Chelsea and Westminster Hospital NHS Foundation Trust, n.d.).
Ice: a cold pack (an ice pack or frozen peas wrapped in a damp towel) applied to the sore area for up to 15 minutes every few hours can give short-term pain relief (University Hospitals Sussex NHS Foundation Trust, 2026). Never put ice directly on your skin.
Gentle movement: rest the arm for the first 1 to 3 days, but keep gently moving your fingers, wrist and shoulder so they do not get stiff (University Hospitals Sussex NHS Foundation Trust, 2026). After that, use the shoulder as much as the pain allows (Chelsea and Westminster Hospital NHS Foundation Trust, n.d.).

Do I Need Shoulder Surgery?

It is not always necessary to have surgery for a shoulder separation. Most people with this injury, even professional athletes, return to normal function without surgery, even if a noticeable bump remains, and recent studies suggest non-surgical treatment may be better than surgery for most types of AC joint injury (American Academy of Orthopaedic Surgeons, n.d.). Grade I and II injuries are treated without surgery, the best treatment for grade III injuries is still debated, and the higher grades (IV to VI) are more often treated with surgery (Nolte et al., 2020).

Before making any decision about surgery, it is important to talk to your doctor about the options available to you.

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Trimming the end of the collar bone: an operation that removes a small part of the end of the collar bone so that it does not rub against the acromion (American Academy of Orthopaedic Surgeons, n.d.).
Ligament reconstruction: an operation to rebuild the ligaments that attach to the underside of the collar bone, used when there is significant deformity (American Academy of Orthopaedic Surgeons, n.d.).

How I can help (see the My Approach tab)

Hands-on work for the neck, upper back and shoulder

Exercises to bring back shoulder movement and strength

Support after surgery, within your surgeon's plan

Tips

Medication: University Hospitals Sussex NHS Foundation Trust (2026) advises taking painkillers, following the instructions on the packet, if you are in pain after a minor AC joint injury. (This medicine information comes from University Hospitals Sussex NHS Foundation Trust, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)
Avoid activities that aggravate the pain.
After a minor injury, avoid lifting your arm above shoulder height for the first two weeks and avoid heavy lifting for about six weeks (University Hospitals Sussex NHS Foundation Trust, 2026).
A minor AC joint injury usually takes 3 to 6 weeks to heal, but you may have symptoms for 3 to 6 months, and a small painless lump at the end of the collar bone may remain (University Hospitals Sussex NHS Foundation Trust, 2026).

Treatment

My Approach

Your doctor decides how it's managed, including whether you need surgery, how long you use a sling and what you can lift. I work inside those limits and check what you've been cleared for. If you've had surgery, I need your surgeon's okay before we start any hands-on treatment.

Once the ligaments have been overstretched, the joint often stays a little looser for good. I can't tighten the joint itself, so my aim is to calm the area down, keep the rest of your shoulder moving, and build the muscles around it so they control the joint for you. I start by assessing how your shoulder and shoulder blade move, your strength, and how your neck and upper back are coping.

Early On

Work on the neck, upper back and other arm, which tighten up while you protect the shoulder
Gentle movement for the main shoulder joint, elbow, wrist and hand, within what you've been cleared for

As It Settles

Cross-fibre work over the irritated ligaments to help them heal and stay mobile
If the joint is stiff rather than loose, gentle mobilisation within its normal range
Strength for the shoulder-blade and shoulder muscles, from light holds to fuller movement, then the lifting and reaching your day asks for
A self-massage routine for when it flares after a busy day

After Surgery

The arm is protected at first, and we only move what your surgeon has cleared
Scar work once the wound has healed
Following your surgeon's plan back to strength once the sling comes off

Never try to push a displaced joint back into place yourself.

What to Expect

Typical Course

Typical course: For a minor injury, visits are usually once or twice a week early on, then weekly as we build strength, spacing out from around six weeks; it usually takes 3 to 6 weeks to heal, though some symptoms can last 3 to 6 months. After surgery, the arm is usually protected for about the first six weeks, and how often we meet and when we load the shoulder follow your surgeon's plan.

What I Focus On

Working Within Your Doctor's Limits

Compensation Relief

Shoulder Mobility

Ligament Cross-Fibre Work

Shoulder-Blade Strength

Sources

References

American Academy of Orthopaedic Surgeons (n.d.) Shoulder separation. OrthoInfo. Available at: https://www.orthoinfo.org/en/diseases--conditions/shoulder-separation/ (Accessed: 7 October 2026).
Nolte, P.C., Lacheta, L., Dekker, T.J., Elrick, B.P. and Millett, P.J. (2020) 'Optimal management of acromioclavicular dislocation: current perspectives', Orthopedic Research and Reviews, 12, pp. 27–44. doi: 10.2147/ORR.S218991
University Hospitals Sussex NHS Foundation Trust (2026) Minor injury to acromioclavicular joint (ACJ grade 1 to 2 injury). Available at: https://www.uhsussex.nhs.uk/resources/minor-injury-to-acromioclavicular-joint-acj-grade-1-to-2-injury/ (Accessed: 7 October 2026).
Chelsea and Westminster Hospital NHS Foundation Trust (n.d.) Acromio-clavicular joint (ACJ) injury. Available at: https://www.chelwest.nhs.uk/your-visit/patient-leaflets/surgery-services/acromio-clavicular-joint-acj-injury (Accessed: 7 October 2026).

Massage therapy · Kitchener–WaterlooAcromioclavicular Joint Separation

What It Is

How It Feels

Signs & Symptoms

Self-Care & Treatment

How to Manage

Do I Need Shoulder Surgery?

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

Early On

As It Settles

After Surgery

Typical Course

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooAcromioclavicular Joint Separation

What It Is

How It Feels

Signs & Symptoms

Self-Care & Treatment

How to Manage

Do I Need Shoulder Surgery?

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

Early On

As It Settles

After Surgery

Typical Course

References

Related Conditions

Biceps Tendon Tear at the Elbow

Biceps Tendon Tear at the Shoulder

Burners and Stingers

Cervical Dislocation

Book a session