What is the presenting case?

Nelson presented to the clinic following a right shoulder injury he sustained playing football following a bump from an opposition player. He was assessed on the sideline and did not return to play. He was referred for an X-ray to determine whether there was any fracture. 

Clinical Findings

Nelson presented approximately three days post injury. He reported that he had a lot of pain over the weekend and considerable difficulty sleeping on his injured side, but seemed to be improving. He complained of a dull ache over his acromioclavicular (AC) joint at rest, and sharper pain with certain movements. His X-ray showed that there were no associated clavicular fractures. On assessment, he had:

• Localised tenderness on palpation of his AC joint
• No obvious step deformity (which would indicate more significant AC joint injury)
• Pain with end of range shoulder movements
• Sharp pain + with horizontal adduction of the shoulder
• Positive ‘pull apart’ AC joint test
• Positive Obrien’s active compression test

Clinical Diagnosis
Grade 1 acromioclavicular joint sprain

What was the end goal?
Return to play (A grade league team)

Interventions

• Initial treatment consisted of ice, anti-inflammatories and a short period of rest/immobilisation in a sling for three days until Nelson’s pain had reduced
• After this initial period, soft tissue work and manual therapy was commenced. This was directed towards:
  • Upper traps, pecs, deltoid and SCM
  • Gentle mobilisations of the AC joint were performed to restore normal movement and range of motion of the shoulder.
• Nelson was guided through a progressive return to train/play program over the next couple of weeks
  • Recommenced running approx. five days post injury. Light skills session e.g. ground balls, kicking/marking as tolerated
  • Modified training sessions with no contact. 1-on-1 bumping/tackling drills etc separate to main training group
  • Full training and match simulation. His AC joint was strapped during each training session to provide support 
  • Nelson had to complete two full training sessions in order to be cleared to return to play
• He was also completing a gym and home-based exercise program to improve strength, proprioception and strength around his shoulder/AC

Outcomes
Nelson was able to successfully to return to playing league football.