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Shoulder pain - Management
How should I manage acromioclavicular joint problems?

  • If osteoarthritis of the acromioclavicular joint is thought to be causing the person's symptoms, see the CKS topic on Osteoarthritis for management recommendations.
  • If the acromioclavicular joint pain is thought to be caused by a sprain following an acute injury:
    • Advise rest and avoidance of cross-body shoulder adduction movements (e.g. golf swing, or weight lifting). Resume activities as tolerated, but avoid heavy lifting and contact sports for 8–12 weeks.
    • Consider providing a sling for 5–7 days if an acromioclavicular joint sprain is suspected.
    • Offer analgesia: paracetamol with or without codeine, or an oral nonsteroidal anti-inflammatory drug (NSAID, e.g. ibuprofen).
    • Consider which drug has a more favourable balance of benefits and risks for the person.
    • If an oral NSAID is indicated, consider gastroprotection with a proton pump inhibitor if the person is:
      • At increased risk of gastrointestinal adverse effects.
      • Subject to dyspepsia from oral NSAIDs.
    • In people at risk of cardiovascular adverse events, ibuprofen up to 1200 mg per day or naproxen up to 1000 mg per day are recommended as first-line options.
    • If there is no early benefit from an oral NSAID, discontinue its use.
    • For more information on minimizing the risks from NSAIDs and when to consider gastroprotection, see the CKS topic on NSAIDs - prescribing issues.
    • Consider referring to physiotherapy after 4–6 weeks if the person responds poorly to rest and analgesia.

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