A hard blow can cause the AC ligament to be stretched or even broken. This is called an AC luxation. Injury to the AC ligament occurs mainly in young avid athletes or the elderly 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 be treated surgically but this depends on several factors. The physiotherapists at Fysiofitaal Tilburg can recognize damage or injury to this joint and are able to guide you in 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 a grade 2 Tossy, the AC ligament is 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 and the coracoclavicular ligament (trapeziod and coniod ligament) are completely torn and the clavicle protrudes clearly upward. Here we also speak of a piano key phenomenon.

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 of AC-Tossy can be made using the client's story along with the physical examination. Usually, the piano-tooth phenomenon is involved. The physiotherapists at Fysiofitaal Tilburg are able to recognize an AC-Tossy.


Sometimes a choice is still made to treat the symptoms surgically. When 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 shoulder blade. When 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.


Grade 1 Tossy: Treatment consists mainly of rest with the help of 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 limits the range of motion in the shoulder.

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 athletic people or those with physically demanding work, an acute surgical procedure is quite often chosen to repair the ligaments. This should then be done within three weeks. In older 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 slightly higher than the shoulder blade.

With both a Tossy 1 and Tossy 2, it is common to use a sling for two weeks. In addition, physical therapy can be started to improve the function of the shoulder again. Pain symptoms may persist for a longer period of time. Treatment consists of advice, mobilizations of the entire shoulder girdle, active exercise therapy and, last but not least, homework exercises. All this will ensure a good recovery!

Recently fallen and suffering from persistent shoulder pain? Contact us at www.fysiofitaal.nl or make an appointment directly by phone!

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