AC instability

A hard blow can cause the AC ligament to be stretched or even broken. We then speak of an AC luxation. Injury to the AC ligament occurs mainly in young enthusiastic athletes or older people after a fall.

  • Tossy 1 (stretching of the ligament)
  • Tossy 2 (ligament damage)
  • Tossy 3 (damage to other ligaments around the clavicle as well).

A Tossy 3 can be treated surgically but this depends on several factors. The physiotherapists at Fysiofitaal Tilburg can recognise damage or injury to this joint and are able to guide you with a conservative policy (physiotherapy)!

To understand the severity of injury to the AC ligament, different grades are used. In a grade 1 Tossy the AC ligament is only slightly stretched (also called a distortion) and sufficient rest will provide the necessary recovery. In grade 2 Tossy the AC ligament is completely torn and the collarbone (the clavicle) sticks up a little. Fortunately, the clavicle is still attached to two other ligaments. In a grade 3 tossi, both the AC ligament and the coracoclavicular ligaments (trapeziod and coniod ligaments) are completely torn, and the collarbone protrudes significantly. Here we also speak of a piano key phenomenon.

Symptoms at different degrees:

Pain when moving the shoulder. Possibly slight swelling can be seen around the joint.

A serious pain at the joint together with swelling. Also the collarbone is a bit higher and when you press on it it moves.

A continuous pain along with swelling and elevation of the collarbone.

The diagnosis of AC-Tossy can be made using the client's story along with the physical examination. Usually there is a piano-key phenomenon. The physiotherapists of Fysiofitaal Tilburg are able to recognize an AC-Tossy.


Sometimes a choice is made to treat the symptoms surgically. When a previous treatment did not help, or when the seriousness of the injury is too big to heal naturally. During surgery the collarbone will be reattached to the original part of the shoulder blade. If there is recurrent instability, it is additionally fastened with the hamstring tendon. The operation is usually performed by means of keyhole surgery (arthroscopy). Using 3 or 4 holes of one centimeter, the injury is extensively examined and then the joint is fixed again.


Grade 1 Tossy: The treatment consists mainly of resting with the aid of a sling/sling. By taking it easy and doing small exercises, this type of tossi injury will heal by itself.

Grade 2 Tossy: It is important that the collarbone remains at the same height as the shoulder blade as much as possible. This is because then the AC can be repaired by scar tissue formation. It is advisable to use a good sling that limits the range of motion in the shoulder.

Grade 3 Tossy: Because the clavicle is elevated, there can be no healing by scarring. The ligaments that are torn will dissolve with time. In the case of young sportsmen and women, or people with a heavy physical workload, an acute surgical procedure is often chosen to repair the ligaments. This should be done within three weeks. With older people or injuries that have been present for a long time, a conservative policy (physiotherapy) is chosen. When this happens, you will always see that the collarbone is positioned somewhat higher than the shoulder blade.

In both Tossy 1 and Tossy 2 it is customary to use a sling for two weeks. In addition, physical therapy can be started in order to improve the function of the shoulder. Pain symptoms can still persist for a long time. The treatment consists of advice, mobilizations of the entire shoulder girdle, active exercise therapy and, of course, homework exercises. All this will ensure a good recovery!

Recently fallen and suffering from persistent shoulder pain? Please contact us via www.fysiofitaal.nl or make an appointment by phone!

Make an appointment