Luxatio, physical therapy, treatment: Focus Physiological✓

The clinical presentation of an acromioclavicular joint dislocation develops immediately after trauma and is characterized by localized, sharp pain along with clear visual and palpable changes at the very top of the shoulder. At the Focus Physical Therapy Center, we carefully analyze these symptoms in order to determine the exact degree of instability.

The most common symptoms include:

• Localized pain at the top of the shoulder: Intense, sharp pain strictly localized over the AC joint, which dramatically worsens with any touch or attempted arm movement.
• “Step-off” deformity (in more severe grades):
  A visible prominence and elevation of the outer end of the clavicle relative to the shoulder contour, creating asymmetry and a noticeable cosmetic deformity of the shoulder girdle.
• “Piano key” phenomenon: A characteristic clinical sign in which pressing the elevated clavicle downward temporarily returns it to its normal position, but it immediately rises again once the pressure is released due to rupture of the coracoclavicular ligaments.
• Restricted movement and pain during horizontal adduction: The patient experiences severe pain when attempting to place the hand of the injured side onto the opposite shoulder (cross-body adduction test), because this movement directly compresses the injured joint.
• Swelling and hematoma: Rapid onset of localized swelling, and depending on the extent of soft tissue and blood vessel injury, bruising may also occur and spread down along the deltoid muscle.
• Reduced strength and inability to raise the arm: The patient instinctively protects the injured arm by holding it close to the body in a guarded position, while active elevation of the arm above shoulder level becomes impossible due to instability and pain.

At the Focus Physical Therapy Center, recognizing these signs in the early stage is a key step toward successful recovery, as it allows us to intervene promptly and prevent acute inflammation from progressing into chronic tissue damage or permanent loss of joint function.

• Direct impacts
• Falls
• Traffic accidents
• Repetitive stress

Acromioclavicular joint dislocation is primarily a mechanical, traumatic injury. It rarely occurs as a result of chronic overuse and is almost always caused by the direct application of force to the structures of the shoulder girdle. At our center, by analyzing the mechanism of injury, we accurately assess the direction of the force and the degree of involvement of the surrounding muscle attachments (the trapezius and deltoid muscles).

The main causes of AC joint dislocation include:

• Direct fall onto the top of the shoulder (Most common cause): Falls from a bicycle, motorcycle, skis, or during contact sports, where the arm remains close to the body, and the full impact force is transferred directly onto the acromion, pushing the scapula downward while the clavicle remains fixed.
• Fall onto an outstretched arm (Indirect trauma): Landing on the palm with the arm fully extended at the elbow and shoulder, where the impact force travels upward through the humerus to the entire shoulder girdle, resulting in shearing stress and rupture of the AC joint ligaments.
• Traffic accidents: Direct blows to the lateral side of the torso and shoulder during car or motorcycle accidents, where high kinetic energy instantly tears the stabilizing soft tissue structures.
• Contact and combat sports: Intense collisions and falls in football, rugby, handball, judo, or wrestling, where mechanical impacts to the shoulder are a routine part of the activity.
• Severe occupational trauma: Falls from height (such as on construction sites) or direct impact of a heavy object onto the clavicle, causing significant mechanical separation of the joint surfaces.

Treatment and physical therapy for acromioclavicular (AC) joint dislocation require patience and a combination of different therapeutic methods, as symptoms do not resolve overnight. The first step in conservative treatment (Grade I and II injuries) involves immobilization of the arm (using a sling or shoulder brace) for 1 to 3 weeks in order to unload the injured ligaments and allow primary healing. During this early phase, home-based cryotherapy (local ice application over the joint several times a day) is essential to control swelling and reduce sharp pain.

At the Focus Physical Therapy Center, AC joint dislocation treatment is carried out through strictly phased and controlled rehabilitation protocols that safely restore shoulder stability and function:

• Functional diagnostics and evaluation: Clinical assessment of the degree of clavicular displacement, examination of skin integrity and neurovascular status of the arm, as well as detailed analysis of X-ray findings (often performed under load) before starting therapy.
• HILT Laser Therapy (High-Intensity Laser Therapy): Applied from the first days after removal of immobilization or during immobilization breaks. Due to its high power, the laser penetrates deeply into the AC joint, accelerates cellular metabolism, significantly reduces inflammatory swelling, and stimulates collagen synthesis necessary for ligament repair.
• Tecar Therapy: A radiofrequency-based therapy used for strong thermal and biostimulatory effects. Tecar therapy relaxes secondary painful spasms of the neck and shoulder muscles (trapezius and levator scapulae), improves local microcirculation, and accelerates hematoma resorption.
• Electrotherapy (TENS and Interferential Currents): Targeted application to block pain signals at the spinal level, reduce acute local inflammation, and stimulate the release of endorphin-producing substances that facilitate the early initiation of exercise therapy.
• Manual Therapy and Mobilization of Adjacent Joints: Gentle manual techniques used by the physiotherapist to maintain mobility of the glenohumeral joint, cervical spine, and scapula, preventing the development of “frozen shoulder syndrome” during immobilization.
• Kinesiotherapy and Dynamic Stabilization: The key phase of recovery, beginning with early passive and pendulum exercises that progressively transition into active-assisted exercises. Special emphasis is placed on strengthening the deltoid and trapezius muscles, which assume the role of dynamic stabilizers and compensate for weakened ligaments.
• Kinesio Taping and Specific Stabilization Techniques: Application of elastic therapeutic tape with high tension above the clavicle in order to mechanically “push” it downward and provide external joint stability, helping the patient safely perform exercises and daily activities.

The combination of these advanced physical therapy modalities and targeted kinesiotherapy programs at the Focus Physical Therapy Center enables maximal functional recovery, restores full range of motion and shoulder girdle strength, minimizes the risk of chronic instability, and allows a safe return to daily and sports activities.