AC joint injury: when the shoulder hurts right at the tip
Sharp pain right at the top of the shoulder after a fall or a direct blow - a common injury in contact sport, different from a rotator cuff tear.
An AC joint injury is a common sporting injury after a fall or direct blow to the tip of the shoulder, completely different from a rotator cuff tear, and in most cases it responds well to conservative treatment.
If you took a direct fall onto the shoulder, or a blow during contact sport, and since then there is sharp, precise pain right at the top of the shoulder - exactly where the collarbone meets the shoulder blade - this may be an injury to the acromioclavicular (AC) joint, also known as a “shoulder separation”.
This is an entirely separate injury from a rotator cuff tear, even though it happens in roughly the same area, and it requires a different treatment approach.
How does it usually feel?
Symptoms can vary, but many describe:
- Focal, sharp pain at the top of the shoulder.
- Direct tenderness at the point where the collarbone meets the shoulder blade.
- Sometimes a slight or prominent bump at the end of the collarbone.
- Pain that worsens when raising the arm overhead or lying on the shoulder.
- Reduced strength in movements involving the upper shoulder.
If you can point exactly at the painful spot at the tip of the shoulder, rather than pointing at the whole area - that points strongly toward this joint rather than the rotator cuff.
What causes an AC joint injury?
Most cases are caused by a direct fall onto the tip of the shoulder, very common in cycling, skiing, football and martial arts, or by a direct blow in contact sport. The severity of the injury ranges from a mild overstretch of the ligaments through to a complete tear, sometimes accompanied by a clear bump of the collarbone.
How can physiotherapy help?
In most mild to moderate cases treatment is conservative - a combination of gradually rehabilitating the range of motion, strengthening the shoulder and shoulder blade muscles, and a controlled return to full activity including sport. The key isn’t to rush load onto the joint before the tissue is ready, even if the initial pain settled relatively quickly.
When should you get checked?
If there’s a clear bump of the collarbone, you can’t move the arm at all, or a fracture is suspected - get imaging and see an orthopedic specialist before starting physiotherapy.
Frequently asked questions
No. This is an entirely different joint, at the top of the shoulder, with a different injury mechanism and different treatment.
In most cases no - only in the most severe injuries with a complete tear of the supporting ligaments. Most cases are treated successfully without surgery.
It depends on the severity of the injury, but usually after gradual rehabilitation of strength and full range of motion - often within a few weeks in mild injuries.
What’s worth remembering?
An AC joint injury is a separate diagnosis from a rotator cuff tear, and in most cases responds well to tailored conservative treatment.
- An AC joint injury is usually caused by a fall or direct blow to the tip of the shoulder, and is distinct from a rotator cuff tear.
- It’s identified by sharp, focal pain exactly at the top of the shoulder, sometimes with a slight bump of the collarbone.
- In most cases treatment is conservative and successful; seek assessment if there is a significant bump or a suspicion of an accompanying fracture.
Not sure if this is your situation? I’d be happy to give you a professional assessment and build a treatment plan that fits you.
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