Hockey players can suffer from a wide variety of injuries ranging from head to toe. Because hockey is a physical sport, lots of these injuries are caused by trauma, or a blunt force distributed to the body. One of the common contact injuries to the upper body is AC joint injuries aka shoulder separation. In this post, we get in to the nitty gritty of what the AC joint is and why AC joint injuries are so common.
What is the AC joint?
The acromioclavicular (AC) joint is the joint where your shoulder blade and collar bone join together at the top of your shoulder. It is held together by 2 ligaments – the coracoclavicular ligament and the acromioclavicular ligament. The coracoclavicular ligament can be divided into 2 smaller ligaments, the conoid ligament and the trapezoid ligament. All 3 ligaments help in maintaining the stability of the AC joint, creating a very stable joint.
The AC joint plays a role in movement of the scapula and helps transmit forces through the shoulder. When the AC joint is injured, it is typically due to tearing of one or more of the aforementioned ligaments.
Why are AC joint injuries so common?
2 studies from Agel et al. (2007) looked at the injuries in men’s and women’s NCAA ice hockey over a certain number of years. Both papers found that AC joint injuries were the 3rdmost common injury to occur during a game, behind concussions and knee injuries. The main cause of these injuries in both men’s and women’s hockey was contact with another player or with the glass/boards.
The most common mechanism of injury for AC joint sprains/dislocations are direct force to the outside of the shoulder which pushes the acromion under the tip of the collar bone (Phadke et al., 2019). Hockey has a high risk for direct impact to the outside of the shoulder with body checking, contact with the glass/boards, or falling.
How to tell if you have an AC joint injury?
Paxinos Sign
The first sign that you may have an AC joint injury is called a Paxinos sign (Krill et al., 2018). Take a look at your shoulders in the mirror. If there is a significant bump on the top of your shoulder, chances are you injured your AC joint. This is caused by the acromion sliding under the tip of the clavicle.
Crossbody reach
Most often when you injure your AC joint, you will have pain with reaching across your body. This movement creates compression of the AC joint and will cause pain.
AC joint palpation
Take your fingers and find your collar bone. Follow your collar bone along to your shoulder and press gently on the tip of the collar bone. If this causes pain, it is likely that you have an AC joint sprain
Treatment of the AC joint
If you think you have an AC joint injury, you should be assessed by a health care professional. Depending on the severity, surgery may be required (Phadke et al., 2019). However, if it is determined that it does not require surgery, conservative treatment has been successful (Li et al., 2014). Initially, a sling may be worn to immobilize the joint but should be taken off as soon as the pain has decreased. Once the sling is removed, regaining full range of motion and strength is priority. Then a progressive return to sport, reintroducing contact once the patient has full pain-free range of motion (Li et al., 2014). It may also be beneficial to use athletic tape or k tape to help stabilize the AC joint when returning to contact sports.
Matt Kelly, PT
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References
Agel, J., Dompier, T. P., Dick, R., & Marshall, S. W. (2007). Descriptive epidemiology of collegiate men’s ice hockey injuries: National Collegiate Athletic Association Injury Surveillance System, 1988–1989 through 2003–2004. Journal of athletic training, 42(2), 241.
Agel, J., Dick, R., Nelson, B., Marshall, S. W., & Dompier, T. P. (2007). Descriptive epidemiology of collegiate women’s ice hockey injuries: National Collegiate Athletic Association Injury Surveillance System, 2000–2001 through 2003–2004. Journal of athletic training, 42(2), 249.
Krill, M. K., Rosas, S., Kwon, K., Dakkak, A., Nwachukwu, B. U., & McCormick, F. (2018). A concise evidence-based physical examination for diagnosis of acromioclavicular joint pathology: a systematic review. The Physician and sportsmedicine, 46(1), 98-104.
Phadke, A., Bakti, N., Bawale, R., & Singh, B. (2019). Current concepts in management of ACJ injuries. Journal of clinical orthopaedics and trauma.
Li, X., Ma, R., Bedi, A., Dines, D. M., Altchek, D. W., & Dines, J. S. (2014). Management of acromioclavicular joint injuries. JBJS, 96(1), 73-84.