AC Joint Sprain (Child)

The AC or acromioclavicular joint is at the end of the collar bone, or clavicle, near the shoulder. The AC joint is made of 4 ligaments that hold the collar bone to the shoulder blade, or scapula. With an AC joint sprain, these ligaments may be partly or fully torn. In both cases this causes pain and swelling at the end of the collar bone. If the ligaments are completely torn, the collar bone will rise up.

AC joint sprains are given a grade depending on whether they are mild, moderate, or severe:

• Grade 1. A mild sprain, with minor damage to the ligament. The collar bone stays in place.
• Grade 2. A moderate sprain. The ligament is partly torn. The collar bone is moved out of place. The injured shoulder may look lower and flatter than the other shoulder.
• Grade 3. The most severe kind of sprain. The ligament is completely torn. The collar bone is no longer joined to the shoulder blade. The collar bone rises up. This creates a bump on top of the shoulder. The ligament heals in this position, so the bump does not go away. It is possible to have surgery to correct the bump. But normal shoulder function will return even without surgery.

An AC sprain will take up to 6 weeks to heal, depending on how severe it is. A sling is often used to keep the shoulder from moving. Or a sling and an elastic wrap around the chest may be used. Exercises to strengthen muscles and improve range of motion are started as soon as possible. Once healed, you can expect your child to have full recovery of shoulder function.

Home care

Medicine

• Your child's healthcare provider may prescribe medicine for pain and inflammation. Or you may use over-the-counter pain medicine as directed by the provider. Follow the provider’s instructions for giving these medicines to your child.
• Always talk with your child's provider before giving these medicines if your child has chronic liver or kidney disease or ever had a stomach ulcer or GI bleeding.
• Don’t ibuprofen to a child younger than 6 months old. 
• Don’t give your child aspirin.

General care

• Make sure your child uses the injured area as little as possible. This will help decrease pain and swelling and allow the area to heal.
• Place an ice pack over the injured area for no more than 20 minutes. Do this every 3 to 6 hours for the first 24 to 48 hours, or as directed. Keep using ice packs to ease pain and swelling as needed. To make an ice pack, put ice cubes in a plastic bag that seals at the top. Wrap the bag in a clean, thin towel or cloth. Never put ice or an ice pack directly on the skin. The ice pack can be put right on any wrap or sling. As the ice melts, be careful to avoid getting the wrap or sling wet.
• Use a sling to keep the shoulder immobilized, as advised by your child’s healthcare provider. Make sure the sling is comfortable and keeps your child’s arm raised, as advised by the provider. Follow the provider’s instructions on how to use the sling. Always ask when your child should wear the sling. Always ask when the sling can be removed.
• A sling alone is often enough. However, sometimes a sling and a wrap around the chest may be used to help ease pain, if needed. This also helps keep the injured arm from moving. Use these devices as advised until your child sees the healthcare provider or the orthopedic doctor. Always ask when the wrap should be worn. Always ask when the wrap can be removed.
• Your doctor, physical therapist, occupational therapist or other healthcare provider will prescribe custom exercises for your child to perform. Have your child follow the exercises prescribed by the provider.. It’s very important for your child to do the recommended exercises. They will help the injured shoulder regain its normal movement.

Follow-up care

Follow up with your child’s healthcare provider, or as advised. The provider may refer to you an orthopedic or bone doctor for an evaluation and ongoing care of the injury.

Any X-rays your child had today don’t show any broken bones, breaks, or fractures.

Bruises and sprains can sometimes hurt as much as a fracture. These injuries can take time to heal completely. If your child’s symptoms don’t improve or they get worse, talk with your child’s provider. Your child may need a repeat X-ray.

Special notes to parents

If your child plays contact sports, make sure he or she wears the right protective gear. Ask your child’s healthcare provider when it will be safe for your child to play contact sports again.

When to seek medical advice

Call your child's healthcare provider right away if any of these occur:

• Your child’s shoulder looks off-balance
• Your child has increased pain, swelling, or bruising
• Your child has increased pain even after using prescribed pain medicine
• Your child has continuing pain 
• Your child’s hand or arm becomes cold, blue, numb, or tingly
• Your child has trouble moving his or her shoulder, wrist, or elbow due to stiffness