PATHOMECHANICS OF

ACROMIOCLAVICULAR JOINT
BY:- MUHIB
MPT 2ND YEAR
 CLINICAL RELEVANT ANATOMY
• Diarthrodial joint with incongruent
articulating surfaces.
• Fibrocartilagenous disc connects clavicle and
acromion.
• The joint is surrounded by a capsule and
stabilized by superior and inferior capsular
ligaments
• Coracoclavicular ligaments (trapezoid and
conoid).
CLINICAL RELEVANT ANATOMY
 AC JOINT FUNCTION
• The primary function of the AC Joint is:
• To allow the scapula additional range of
rotation on the thorax
• Allow for adjustments of the scapula (tipping
and internal/external rotation) outside the
initial plane of the scapula in order to follow
the changing shape of the thorax as arm
movement occurs.
• The joint allows transmission of forces from
the upper extremity to the clavicle
 STABILITY
Static stability is provided by
• AC ligament: controls horizontal stabilty in
anteroposterior plane
• CC ligaments:- control vertical stability
• conoid part attaches posteriorly and medially on
the clavicle
• trapezoid part attaches anteriorly and laterally.

Dynamic stability:-
• dynamic stability is provided by trapezius and
deltoid muscles
 NORMAL BIOMECHANICS OF AC
JOINT
Motion of the AC Joint are described as scapular
movement with respect to the clavicle,
including:-
• Upward/Downward Rotation about an axis
directed perpendicular to the scapular plane
facing anteriorly and medially.
• Internal/External Rotation about an
approximately vertical axis.
• Anterior/Posterior tipping or tilting about an
axis directed laterally and anteriorly.
 PATHOLOGY
• injuries to the AC joint accounts for approx 10
percent of acute injuries to the shoulder with
seperations of the Ac joint accounting for 40
percent of all shoulder injuries in atheletes.
• The injury is frequently seen in hockey and
rugby players, but is also seen in alpine skiing,
snowboarding, football, cycling and motor
vehicle accidents.
COMMON MECHANISM OF
INJURIES
(A) a direct force onto the point of the shoulder
(B) indirect forces to the AC joint can also cause
injury. For example, a fall on to the elbow can
drive the humerus proximally, disrupting the AC
joint. In this case, the force is referred only to
the AC ligaments and not the coracoclavicular
ligaments
 CLINICAL PRESENTATION
• With an AC joint injury pain is often felt
radiating to the neck and deltoid. The AC joint
may also become swollen, the upper
extremity often held in adduction with the
acromion depressed, which may cause the
clavicle to be elevated.
ROCKWOOD GRADES OF INJURY
 CHANGES IN THE MUSCLES
SURROUNDING THE AC JOINT
• the main muscles which are affected the most
in ac joint pathologies are mainly trapezius
and deltoid.
 EFFECTS OF WEAKNESS OF
TRAPEZIUS
• standing posture with upper traps weakness is
charecterised by depression abduction and
forward tilting of the scapula.
• may also be the result of insufficient resting
tone in the weakened upper trapezius.
• postural abnormalities may also occur with
whole trapezius wekaness.
• weakness of the isolated middle trapezius is
unusual but can occur as a prolonged stretch
on the muscle as might occur in a posture
charecterised by scapular abduction.
• loss of middle traps strength also presents
difficulties when contracting glenohumeral
muscles.
• decreased scapular adduction strength can
allow lateral rotators to pull the scapula
towards the humerus instead of pulling
humerus towards the scapula.
 EFFECTS OF TIGHTNESS OF
TRAPEZIUS MUSCLE
• tightness of the upper traps is associated with
elevated shoulders or asymmetrical head
positions as well as restricted neck and head
ROM.
 CHANGES IN DELTOID MUSCLE
• weakness of ant deltoid produces weakness in
shoulder flexion and can result in diminished
strength of shoulder medial rotation shoulder
abduction and horizontal addiction.
• tightness of ant deltoid results in diminished
extension of shoulder and lateral rotation.
• weakness of middle deltoid results in
weaknened abduction but does not eliminate
active abduction of shoulder.
MOBILIZATION TECHNIQUES IN AC
JOINT PAIN AND RESTRICTION
• Generally in more acute stages, posterior to
anterior ACJ mobilizations in supine with the
arm resting at the side are effective.
• this is the resting position of the joint as well
allowing for more mobility.
• certain patients may only have pain and
limitations at end range of motion. To reach full
humeral flexion and external rotation at least 30
degrees of upward rotation and 8 degrees of
external rotation is needed. (Teece 2007). An
example of a more advanced manual technique
is a posterior to anterior mobilization at end
range using the arm as a lever. In this position,
the therapist's hand blocks movement of the
distal clavicle so that acromion is mobilized on
the stabilized clavicle. Small oscillations of the
humerus are made at the end-range promoting
movement at the ACJ.
THANK YOU