AC Joint Shoulder Injuries with Wil Seto

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto of Insync Physio in Vancouver. Multi time award-winning physiotherapy clinic. Wil's the owner, the big cheese and he's booked out all the time. It's really hard to get into because he's so good at what he does. Today we're going to talk about AC joint shoulder injuries. How are you doing Wil? 

Wil: Good. I'm good. Thanks Mark. Hey Mark, I was just wondering, you know, I know that you always love pumping up my tires, that's great., I thank you for that. But we also have a great team of other physios that actually, you know that, since we're talking about shoulder injuries that actually have a special interest in shoulders too.So I just thought I'd mention that. 

Mark: Of course, I having been to your clinic many times. I know that that's the case. You're the guy here that's the face of the business right now today though. So that's why I did that. All the team, you hold everyone to a really high standard. I know that's how you operate. That's just your nature. And so that's how the team is at Insync Physio. How does someone actually injure the AC joint? And what is it? 

Wil: Yeah, so let's start off with what it is first. So when we think of like the shoulder joint and shoulder injuries, we quite commonly think of like a part of the shoulder. That's the ball and socket. It gives us this 360 degrees range of motion. Well, we also have another part that's part of the shoulder complex, which is where the collarbone connects to your shoulder blade, which is basically called the AC joint or short for acromioclavicular joint. And it's not injured as common or the injuries that happen in the AC joint are not as common as the ball and socket joint area, but we are still seeing this in the clinic. 

Over last couple of weeks, we've had a few people that have come in with it. And so I thought we talked about it. And usually it's from a blunt force or trauma. So in the athletic population, you know, impact sports, when you have like a shoulder to shoulder contact. Really good example is we've had some of our therapists who've worked with hockey teams and they see one of their players get checked into the boards, kind of face first and the shoulder impacts the boards and that's a very common way of injuring the AC joint.

 And another one, it doesn't have to be from athletics or from sports, but it could be like a car accident. Like you got the seatbelt on and it's an impact force with the seatbelt over the collarbone area. And then it's just a sudden jarring motion. 

Another one is also where you could be just maybe moving. I know a client of ours, one of the physios, they were helping someone move and then they're kind of holding something heavy in this position. And then they ended up just having a shoulder to shoulder sort of contact by accident. And then it caused a mild sprain in the AC joint. 

Mark: And I guess falling, that would be another cause, like with your arm out. Could that also do injury to that joint? 

Wil: Yeah, it can actually cause some impact loading forces onto that joint as well, causing some strain. And actually not what we're talking about. Sort of, other types that's non traumatic. It can actually be non traumatic. It can be something that presented as more wear and tear. And so there's special tests that we do in the clinic that kind of determine if your AC joint is affected. We don't just have one test. We have a few different ones that we do, and we cluster them and it actually provides good reliability and accuracy.

Mark: So once you've diagnosed it, which I'm sure is pretty complicated because it could feel like it's referring from the ball and socket joint into the AC, or is it specific to the AC, like someone's going to feel it there in the clavicle, in their collarbone, kind of where it inserts into the scapula. What's the symptoms that someone might notice?

Wil: Yeah, you definitely get like swelling. So there's the more obvious ones is you see it and be red hot and swollen. There's definitely pain and loss of this function. So even with an acute injury, that's something that you want to actually immobilize right away because it's going to be painful and you want to just let things settle down.

So if it's like an acute sprain into that AC joint and you see swelling in there and the pain and dysfunction is obvious. You want to just put it in a sling, for at least a few days you know, to let it settle down. But you do want to get it moving a little bit after that obviously. But you want to give it a chance to really settle down and heal. But the other symptoms too, that if you look at the AC joint, you have a lot of ligaments in there. And so we actually can test for it. But sometimes it can get to a degree where it's so severe where you can see not only a step deformity, so it's very obvious, but then you also get a lot of pain with that too.

Quite often too, if it is fully torn. And there's a step deformity, there can be no pain. Which is almost contradicting. And the reason why, and we've seen this a lot before, is because when there is a step deformity, but there's no pain is because the ligaments have been totally ruptured and the nerve supply is basically not there anymore. And so you can't feel it. But like there's a loss of range of motion. I mean, they feel the initial pain and swelling, but once that goes down and the step deformity is still there. They still have the dysfunction, but it just doesn't hurt. But they had the loss in strength and the loss and stability in that area.

Mark: So how would it present? Is it going to present similar to a broken collarbone? If that was up in that nearer to that area? 

Wil: No, that's a really good question, Mark, thank you. So when you're looking at the sprain of the AC joint, it's kind of more on the outside, closer to that ball and socket, and you can see the swelling in that joint area. And so in that area that you'll have the swelling. And whereas like with a fracture, you can feel along the line of the bone. And if it's a hairline fracture, it's gonna be a little bit tougher because you'll feel maybe sensitivity. It could be muscular is kind of hard to tell.

But if it's like something that's more obvious, then you're going to see a little more of a step deformity in there too. And that's obviously not good. But the presentation is different. And if there's any question, you know, especially if it's trauma related, then we probably want to go get that checked out more medically too. And that's important as a next step. 

Mark: So you've diagnosed it. If there need to be x-rays done. Medical consultation. Their course of treatment is underway, but now they come back. Okay. Now I want to get my range of motion and strengthening and proper function again. How does that course of treatment usually run?

Wil: Yeah. So stability is the key thing, because stability is the number one thing that we want to try and achieve in that joint, above strength and making sure that we progress that stability throughout the whole range and full mobility. And so we don't want to start doing things to strengthen it right away until we achieve that stability strength.

So what I'm talking about is like, you don't want to be doing like pushups and presses and stuff like that. Sort of an old school thinking of like, you know, if we can just strengthen it, which in other areas like your ankle, that's really good. You want to strengthen, you sprained the ligaments. In the AC joint, you got to really work on stabilizing strength. Specific things to actually really stabilize that joint, to make sure that then we can progress through the stages of healing properly.

And so depending on the severity of the injury, there's going to be different stages that you move through in terms of progressing back to like sport, especially, or to work if that's a big thing where you need to use your shoulder for. 

Mark: So what's the difference between them? What kind of exercises is that that are the stability, what you would classify as the stability exercises or steps that someone would need to take that you would guide them through?

Wil: Yeah so, a lot of it is like functional core starting off with basic core and progressing the functional core stuff. The rotator cuff strengthening is really essential. It will help and then working on a lot of stuff around that area to target certain muscles in addition to the rotator cuff, like into the shoulder blade. So there's all these stabilizing muscles.

So there's tests that we can do to look at which muscles are definitely weaker. And usually someone that has an injury, they'll show these patterns right away. And if you have a preexisting injury, like I'm thinking about a client who came in to see one of our physios, that had a pre-existing rotator cuff injury, didn't actually have trauma in the AC joint, but had some pain there as well, you know, they're presenting with other stuff.

So this is where we need to tailor and personalize the things that we need to do with you on a hands-on, you know, one-on-one sort of, okay, we gotta get this moving this way and realign the shoulder blade in this way, and then retrain the specific movement pattern for you. 

Mark: And movement pattern is really important for the shoulder joint. Is that a useful assumption?

Wil: Absolutely 100% because especially when I talked about earlier, that in the shoulder socket where it's ball and socket, it's 360 degrees of movement. And then you have your shoulder blade, which is basically a floating, it's like it's got all these other muscle attachments. And it's sort of floating around in there and it's only real attachment to like, your arm bone, and then your collar bone. So then you have all these other muscles that control and dictate how your shoulder moves. And so having that movement pattern and optimizing the best way to get it working again, especially after you know, like a sport injury, you want to get back to playing sports or work, you know, to be able to do, doing the repetitive motion, or whatever it is that you need your arm to be able to be in that position, is super important.

Mark: In other words, it takes an expert really diagnose it and help you through the process because you might think it's okay because you're free of pain and then you actually are using other muscles and other functioning is happening to take over something that didn't heal properly or hasn't been activated properly. Is that right? 

Wil: Yep. Pretty much. And then you made an interesting point about feeling like it's okay. And a lot of people, they get up to like maybe 85% and then, or they get back to being able to play their sport and they feel like they're 85% and we can get by. You know, and this is also where I talked about the getting intervention in terms of maybe on a medical aspect because like there's a lot of ligaments in there and the classification is quite complex, but you know, it may warrant a referral to see a specialist about what's another route to take. If the rehab approach is just not successful.

Mark: That whole knife thing. Perhaps. 

Wil: Possibly. So that's why we want to work with a team of sports medicine doctors as well and other doctors to kind of get that process going for that. Possibly. 

Mark: If you want a team that's going to really help you diagnose exactly what's going on, whether you have pre-existing injuries, whether it was a blunt force trauma, whether it's arthritic or some kind of thing like that. Insync Physio are the guys to get in touch with. You can reach them at their website insyncphysio.com. You can book for either office in Vancouver or in North Burnaby. And of course, if you want to book and see Wil, you can reach him at 604-566-9716. Or any of the team, they're all top notch. He wouldn't have them there if they weren't. Insyncphysio.com. Thanks Wil. 

Thanks, Mark.