AC Joint Clicking - Back to Front

[Gerald Mangona]

As I've been continuing to be cognizant of scapular position, I've noticed some clicking on the AC joint on my right side.

I've been trying to be hyper aware of it and now think I can accurately describe it.

- It takes place when going from scapular retraction to protraction, never from protraction to retraction.

- I have been able to avoid it completely in both directions by keeping my scapula elevated.

- The problem becomes significantly worse as I move to a neutral position between elevation and depression.

- When the scapulae are fully depressed, it's unavoidable and somewhat painful.

- Right side only.

So when I've been doing shoulder mobility (like push-up plus for example), I've avoided by elevating the scapulae when moving from back to front. When doing work to mobilize the lower traps, I depress hard while retracting, then I relax the shoulders, elevate them to bring them back to their starting position.

Am I doing the right thing?

Will the clicking go away as I gain more strength through full ROM?

Is there something structurally wrong with my movement?

The clicking happens just as transition from retraction and cross the body axis and transition to protraction. (sorry if I'm not using the right anatomical vocabulary.)

Thx, J

[Cole Dano]

It's always tough to try and diagnose online, so take this as some ideas that may or may not help.

I have seen cases of folks over depressing the scaps. If you imagine a top view of the shoulder girdle, the scapula and clavicle form an open triangle that sit atop the ribcage. The ribcage narrows at the top and widens as it goes down. If you over depress it can mean that triangle has to somehow enlarge in order to fit. This can put extra strain on the sternoclavicular joint.

If this is the issue you just have to experiment with finding the right amount of depression for a given part of a movement.

Of course there are many other movements which place demands on the sternoclavicular joint which only a methodically building up of muscular and connective tissue strength will cure, but sometimes there can also be the issue of exaggerating scapular positioning.

[Joshua Naterman]

The *most* likely cause would be an impinged and/or swollen,inflamed subacromial bursa, but in theory it could also be an inflamed supraspinatus. There aren't a whole lot of structures between the AC joint and the humerus.

This could also be happening because of poor stabilization of the humeral head in the shoulder socket itself, which has been an issue for me. A lot of specific external rotator work really helps, but don't try to use full ROM. Try to use the best rom that you can tell for sure doesn't cause any shifting either of the scapula OR of the upper arm bone in the socket.

Lying on your side at a slight upward angle (10-15 degrees) with the elbow of your exercising arm resting on a rolled up towel and performing external rotations from the lowest you can go without issues to slightly above parallel with the ground, taking 2-3 seconds on the way up and 3-5 seconds on the way down is a great way to go. You'll want to pick a weight that you can do this with for at least 60 seconds. 3 sets to failure is the way to go. This should be light enough to where you can reach muscular failure without compromising form.

As you become more stable you can also try the external rotation exercise that Poliquin likes a lot. Search for poliquin external shoulder rotation exercise on Google for some information on how to do the exercise. If it feels good to you right now, go for it. If not, do the first for a month or two and then try it again.

[Cole Dano]

AC joint!

[Joshua Naterman]

AC joint!

Hey, look at the bright side Now you have a perfect post to cut and paste for when someone has SC pain!

[Cole Dano]

True. The thing that set me to think about that is the fact the OP emphasized heavy scapular depression, I think some of what I said can apply here as well as even more of the stress from over-depression will go into the AC joint, as there is more leverage there, though it's a very strong joint.

Josh's post being more at the tissue level, and rehab level, mine on looking for healthy not exaggerated ROM, IF the over-depressing is part of the cause of the irritation.

One thing for sure, clicking at the AC joint is something to be careful with, this is a very stable joint, sounds coming from the joint itself along with pain means you need to take care.

[Nic Branson]

Check your neck mobility also. Scalene triggers can add to all sorts of pain in numerous places.

Good advice already no need to add on to it from me other than the neck bit above.

[Joshua Naterman]

Over-depression will absolutely make impingement an issue, so you're right on the money there. Healthy ROM is key! Always go by feel. The range of motion should never hurt.

If there is pain at the AC itself, like palpation of the bony joint is painful, I would check for a piano sign (press down on the collarbone near the AC joint. If it moves, that's not normal. If it hurts, that's not normal. Those results would indicate some degree of AC ligament strain, but I would honestly be surprised if that was the case here unless there is a history of traumatic injury to the AC. It's such a ridiculously strong joint that injuring it with any degree of voluntary depression and movement is highly unlikely.

The neck is definitely a good call. Always take a look at all the muscles that attach near or to any of the involved bony areas.