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Ac instability.

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

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

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

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 a grade 2 Tossy, the AC ligament completely torn causing the clavicle (the clavicle) to stick up slightly. Fortunately, here the clavicle is still attached to two other ligaments. In a grade 3 tossi, both the AC ligament if the coracoclavicular ligaments (trapeziod and coniod ligament) are completely torn and the clavicle protrudes markedly upward. Here we also speak of a piano key phenomenon.

Fysio Fitaal physiotherapy for AC complaints in Tilburg
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Symptoms at different grades:

Pain When moving the shoulder. Slight swelling may possibly be seen around the joint.

A serious pain at the level of the joint along with swelling. Also, the clavicle is a little higher and when you press on it, it is mobile.

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

The diagnosis AC-Tossy can be posed using the client's story along with the physical examination. In most cases, the piano-tooth phenomenon is involved. The physiotherapists at Fysiofitaal Tilburg are able to provide a AC-Tossy recognize.


Sometimes a choice is still made to treat the symptoms surgically. When a previous treatment has not helped or when the severity of the injury is too great to heal naturally. During surgery, the clavicle is reattached back to the original part of the scapula. If there is recurrent instability, it is additionally attached with the hamstring tendon. The surgery is usually performed through keyhole surgery(arthroscopy). With 3 or 4 one-centimeter holes, a comprehensive look at the injury is taken and then the joint is reattached and the wounds closed.


Grade 1 Tossy: Treatment consists primarily of rest using a sling/ sling. By taking it easy along with small exercises this form of tossi injury will heal on its own.

Grade 2 Tossy: It is important to keep the clavicle at the same height as the scapula as much as possible. This is because through scarring then the AC can be restored. It is advisable to use a good sling that allows movement in the shoulder blade. shoulder limited.

Grade 3 Tossy: Because the clavicle is significantly elevated, there can be no repair using scarring. The ligaments that are torn will dissolve with time. In young sporty people or those with physically demanding work, an acute surgical procedure is quite often chosen to repair the ligaments. This must then be done within three weeks. With elderly people or injuries that have been present for some time, a conservative policy (physical therapy) is chosen. So when this happens you always see that the clavicle is a bit higher than the shoulder blade.

physio fitaal physiotherapy

With both a Tossy 1 and Tossy 2, it is common to use a sling for two weeks. In addition physiotherapy to be initiated to improve the function of the shoulder improve again. However, pain symptoms may persist for a longer period of time. The treatment consists of advice, mobilizations of the entire shoulder girdle, active exercise therapy and not to forget homework exercises. All this will ensure a good recovery!

Recently fallen and suffering from permanent shoulder pain? Take contact at or make an appointment directly by phone!

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