# Acromioclavicular joint dislocation - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Acromioclavicular Joint Injury - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK493188/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class LD48.01 - condition scope only, no dose · MSF Essential Drugs 2024 - paracetamol (oral) · MSF Essential Drugs 2024 (ibuprofen oral monograph) - Verified date: 2026-08 ## Verified against - Acromioclavicular joint dislocation - disease-level clinical article (ac-joint-dislocation-full.txt) - MSF Essential Drugs 2024 - paracetamol (oral) - MSF Essential Drugs 2024 (ibuprofen oral monograph) ## Treatment metadata - Paracetamol — 500 mg — oral.solid - Ibuprofen — 400 mg — oral.solid - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text ACROMIOCLAVICULAR JOINT DISLOCATION Sources: Acromioclavicular Joint Injury - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK493188/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class LD48.01 - condition scope only, no dose · MSF Essential Drugs 2024 - paracetamol (oral) · MSF Essential Drugs 2024 (ibuprofen oral monograph) Review status: REVIEWED against Acromioclavicular joint dislocation - disease-level clinical article (ac-joint-dislocation-full.txt), MSF Essential Drugs 2024 - paracetamol (oral), MSF Essential Drugs 2024 (ibuprofen oral monograph) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (2) - Pain over the top of the shoulder follows a fall onto an outstretched arm or a direct blow to the shoulder - Pain may radiate toward the neck and worsens with movement or lying on the injured side SIGNS - what you find (4) - Visible swelling, bruising, or deformity may be seen over the AC joint, with tenderness on palpation [bruising · visible deformity] - Active and passive shoulder motion may be limited by pain - The piano key sign - the clavicle lifts and springs back down when pressed - The rest of the clavicle and the sternoclavicular joint should be checked for associated injury, plus a neurovascular exam of the arm TESTS (5) - Plain x-rays are usually enough to diagnose the injury and rule out other causes of shoulder pain - A Zanca view, an AP film angled 10 to 15 degrees toward the head, can show injuries standard views miss - Comparing both shoulders on x-ray, or adding weighted stress views, helps clarify an uncertain diagnosis - Ultrasound or MRI can be used if the diagnosis remains unclear - Measuring the coracoclavicular interspace distance against the other shoulder guides treatment decisions IF NOT THIS - what else fits (5) - Distal clavicle osteolysis, AC joint arthritis, or an acromion fracture can mimic this injury - Frozen shoulder, anterior subluxation of the humerus, or complex regional pain syndrome are alternatives - An Erb-Duchenne brachial plexus injury, a labral tear, or an unfused os acromiale should also be considered - A rotator cuff injury or a superior labral tear can present similarly - Septic arthritis of the joint or a true shoulder dislocation are important not to miss Source StatPearls "Acromioclavicular Joint Injury" - disease-level clinical article Status traced to the source above Rx: Pain | Main treatment PAIN - choose one 1. PARACETAMOL [1st line] Adult 1 g (two 500 mg tablets) 3 or 4 times daily, to a maximum of 4 g in 24 hours. - Through the first weeks in the sling, while movement is being regained. Peds 15 mg/kg/dose [child max 500 mg] (Child 1 month and over: 15 mg/kg 3 or 4 times daily, to a maximum of 60 mg/kg in 24 hours. Child under 1 month: 10 mg/kg 3 or 4 times daily, to a maximum of 40 mg/kg in 24 hours. A single dose is capped at 500 mg because the top band of MSF's own weight table, 30 to under 50 kg, is one 500 mg tablet three times daily.) 3kg -> 45 mg/dose 4kg -> 60 mg/dose 5kg -> 75 mg/dose 6kg -> 90 mg/dose 7kg -> 105 mg/dose 8kg -> 120 mg/dose 9kg -> 135 mg/dose 10kg -> 150 mg/dose 11kg -> 165 mg/dose 12kg -> 180 mg/dose 13kg -> 195 mg/dose 14kg -> 210 mg/dose 15kg -> 225 mg/dose 16kg -> 240 mg/dose 17kg -> 255 mg/dose 18kg -> 270 mg/dose 19kg -> 285 mg/dose 20kg -> 300 mg/dose 21kg -> 315 mg/dose 22kg -> 330 mg/dose 23kg -> 345 mg/dose 24kg -> 360 mg/dose 25kg -> 375 mg/dose 26kg -> 390 mg/dose 27kg -> 405 mg/dose 28kg -> 420 mg/dose 29kg -> 435 mg/dose 30kg -> 450 mg/dose 31kg -> 465 mg/dose 32kg -> 480 mg/dose 33kg -> 495 mg/dose 34kg -> 500 mg/dose (capped) 35kg -> 500 mg/dose (capped) 36kg -> 500 mg/dose (capped) 37kg -> 500 mg/dose (capped) 38kg -> 500 mg/dose (capped) 39kg -> 500 mg/dose (capped) 40kg -> 500 mg/dose (capped) 41kg -> 500 mg/dose (capped) 42kg -> 500 mg/dose (capped) 43kg -> 500 mg/dose (capped) 44kg -> 500 mg/dose (capped) 45kg -> 500 mg/dose (capped) 46kg -> 500 mg/dose (capped) 47kg -> 500 mg/dose (capped) 48kg -> 500 mg/dose (capped) 49kg -> 500 mg/dose (capped) 50kg -> 500 mg/dose (capped) Source MSF Essential Drugs 2024 - paracetamol (oral) Why Paracetamol is MSF's analgesic for mild to moderate pain and the one usable in almost every patient. The article manages a type I or type II acromioclavicular sprain without an operation - a sling, analgesia, ice and physical therapy - and its rehabilitation schedule repeats that adequate analgesia is provided through the first weeks. It names no drug and no amount, so the amount is MSF's. Caution A grossly deformed joint, skin tented over the end of the clavicle, or any neurovascular injury needs orthopaedic assessment, not a longer course of an analgesic. Never exceed 4 g in 24 hours in an adult, or 60 mg/kg in 24 hours in a child. MSF warns that paracetamol poisoning is severe - it causes hepatic cytolysis - and that the stated limits matter most in children and in older patients. MSF records no contra-indication in pregnancy or in breast-feeding, and names paracetamol as the analgesic of choice for a patient allergic to aspirin, one with a history of gastric trouble, a pregnant or breast-feeding woman, and children. Paracetamol has no anti-inflammatory action, so it eases the pain and does nothing for the swelling. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid 2. IBUPROFEN [1st line] Adult 200 to 400 mg 3 to 4 times daily as required, to a maximum of 1,200 mg in 24 hours. Take it with food and keep doses at least 4 hours apart. - A short course while the sprain is acutely inflamed. Peds 5-10 mg/kg/dose [child max 400 mg] (Child over 3 months: 5 to 10 mg/kg 3 to 4 times daily, to a maximum of 30 mg/kg in 24 hours. Nothing under 3 months of age. A single dose is capped at 400 mg, which is the adult single-dose maximum in the same MSF entry.) 3kg -> 15-30 mg/dose 4kg -> 20-40 mg/dose 5kg -> 25-50 mg/dose 6kg -> 30-60 mg/dose 7kg -> 35-70 mg/dose 8kg -> 40-80 mg/dose 9kg -> 45-90 mg/dose 10kg -> 50-100 mg/dose 11kg -> 55-110 mg/dose 12kg -> 60-120 mg/dose 13kg -> 65-130 mg/dose 14kg -> 70-140 mg/dose 15kg -> 75-150 mg/dose 16kg -> 80-160 mg/dose 17kg -> 85-170 mg/dose 18kg -> 90-180 mg/dose 19kg -> 95-190 mg/dose 20kg -> 100-200 mg/dose 21kg -> 105-210 mg/dose 22kg -> 110-220 mg/dose 23kg -> 115-230 mg/dose 24kg -> 120-240 mg/dose 25kg -> 125-250 mg/dose 26kg -> 130-260 mg/dose 27kg -> 135-270 mg/dose 28kg -> 140-280 mg/dose 29kg -> 145-290 mg/dose 30kg -> 150-300 mg/dose 31kg -> 155-310 mg/dose 32kg -> 160-320 mg/dose 33kg -> 165-330 mg/dose 34kg -> 170-340 mg/dose 35kg -> 175-350 mg/dose 36kg -> 180-360 mg/dose 37kg -> 185-370 mg/dose 38kg -> 190-380 mg/dose 39kg -> 195-390 mg/dose 40kg -> 200-400 mg/dose 41kg -> 205-400 mg/dose (upper capped) 42kg -> 210-400 mg/dose (upper capped) 43kg -> 215-400 mg/dose (upper capped) 44kg -> 220-400 mg/dose (upper capped) 45kg -> 225-400 mg/dose (upper capped) 46kg -> 230-400 mg/dose (upper capped) 47kg -> 235-400 mg/dose (upper capped) 48kg -> 240-400 mg/dose (upper capped) 49kg -> 245-400 mg/dose (upper capped) 50kg -> 250-400 mg/dose (upper capped) Choice Alternatives, and the article does not rank them - the order below is set here. The article says only that adequate analgesia is provided through the first weeks and names no drug at all. Ibuprofen leads because a grade I or II acromioclavicular sprain is an inflamed ligament and the anti-inflammatory acts on the swelling as well as the pain. Paracetamol is the choice for anyone an NSAID is barred in - peptic ulcer, kidney disease, asthma worsened by NSAIDs, anticoagulation, the third trimester. Source MSF Essential Drugs 2024 (ibuprofen oral monograph) Why Ibuprofen is MSF's non-steroidal anti-inflammatory for mild to moderate pain, and it acts on the inflammation of the sprained ligaments as well as the pain. The article manages a type I or type II acromioclavicular sprain without an operation - a sling, analgesia, ice and physical therapy - and its rehabilitation schedule repeats that adequate analgesia is provided through the first weeks. It names no drug and no amount, so the amount is MSF's. Caution Look for an associated clavicle fracture, a sternoclavicular injury or a neurovascular insult on the same arm before settling for a sprain. Not for a child under 3 months. MSF also contra-indicates ibuprofen in allergy to any NSAID, peptic ulcer, coagulation defects, haemorrhage, surgery carrying a risk of major blood loss, severe renal or hepatic impairment, severe heart failure, severe malnutrition, uncorrected dehydration or hypovolaemia, and severe infection. Avoid in pregnancy. MSF contra-indicates it outright from the beginning of the sixth month and names paracetamol as the substitute. Short-term use while breast-feeding carries no contra-indication. Give with caution to an older or an asthmatic patient. Do not combine it with methotrexate, with an anticoagulant, or with another NSAID, and watch the combination with a diuretic or an ACE inhibitor - MSF's instruction there is to drink plenty of fluids to avoid renal failure. It may cause allergic reactions, epigastric pain, peptic ulcer, haemorrhage and renal impairment. Egypt DAJUANOFEN 400 MG 20 F.C. TABS. COPAD PHARMA 5.00 EGP (0.25/unit) FLABU 400MG 10 F.C.TAB. DELTA PHARMA 3.75 EGP (0.38/unit) NOVA-PROFEN 400MG 30 F.C. TABLETS SANOFI 12.75 EGP (0.42/unit) IBUPROFEN 400 MG 10 TAB. SEDICO 6.00 EGP (0.60/unit) MAFO 400 MG 30 F.C.TABS EIPICO 42.00 EGP (1.40/unit) BRUFEN 400 MG 30 TABS. KAHIRA > ABBO... 78.00 EGP (2.60/unit) PROFUSOL 400MG 20 S.G CAPS. EUROPEAN EGYP... 31.00 EGP ANALGIPROF 400 MG 25 SACHETS EVA PHARMA 37.50 EGP NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP -> ? strength differs, ? different route - not oral solid BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 EGP -> ? strength differs, ? different route - not oral solid MAIN TREATMENT 3. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult AC joint injury from a fall onto the shoulder or a direct blow; low-grade injuries are managed with a sling and analgesia, higher-grade separations need orthopedic referral. - Refer, with advice Peds A child is dosed from the drug rows above, by weight. The referral threshold and the safety-netting are the same at any age. Source No dose - referral pathway, no medicine given in primary care Why AC joint injury from a fall onto the shoulder or a direct blow; low-grade injuries are managed with a sling and analgesia, higher-grade separations need orthopedic referral. Caution Marked deformity or skin tenting over the joint, neurovascular injury, high-grade separation. The drug rows above are what the treating service gives. They are here so that the referral is an informed one and so the GP can recognise the regimen the patient comes back on - not as permission to start it without the referral. RED FLAG - Evaluate for associated clavicle fracture, sternoclavicular injury, or neurovascular insult on the affected extremity. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)