A shoulder separation sounds like an odd injury, but in reality, it refers to the stretching or tearing of ligaments where the collarbone (clavicle) meets the shoulder blade (scapula). This intersection is also called the acromioclavicular or AC joint. When these ligaments partially or completely tear, the clavicle slips forward and may detach from the scapula.
A shoulder separation is usually the result of an impact or blows to the front of the shoulder or by falling on an outstretched hand.
Separation vs. Dislocation
A shoulder dislocation is different from a shoulder separation, occurring at a different part of the shoulder joint, and it is treated differently.
A dislocation occurs at the glenohumeral joint, where the humerus bone of the upper arm articulates on the scapula, rather than the AC joint. Shoulder dislocation is treated by being reduced.
Symptoms and Signs
Shoulder pain and tenderness are common symptoms of a shoulder separation after a fall or impact. Sometimes there is a small bump on top of the shoulder along with bruising and swelling. Signs and symptoms of shoulder joint injuries range from a minor deformity and mild pain to a very painful and severe deformity.
Severity and Type
The severity of the separation is determined by the amount and direction of joint separation and ligament damage that shows up on x-rays.
Type I and II AC joint injuries are considered mild and may respond to conservative treatment. In more severe type IV, V, and VI shoulder separation injuries, the supporting ligaments may actually be torn. These injuries are generally treated with surgery.
Treatment courses depend on the specific type of injury.
Type I and II AC Joint Injury Treatment
Treatment for type I and II AC joint injuries generally includes conservative treatments including:
- Rest to allow the damaged tissues to heal
- Support and slings to take pressure off the joint
- Ice to reduce swelling and inflammation
- Over-the-counter pain and anti-inflammatory medications
- Physical therapy exercises to increase range of motion and strength
Type III AC Joint Injury Treatment
Treating mild to moderate, or type III, AC joint injuries are not as clear. There is some controversy among surgeons as to whether to use conservative treatments or surgery for a type III shoulder separation. Most patients with type III shoulder separations heal well with conservative treatment and return to sports faster than patients who have surgery. In addition, they avoid any risks of surgery.
However, some patients may benefit from a surgical procedure. Those patients who are involved in heavy labor or play sports that require frequent overhead motions, such as tennis or baseball, may benefit more from surgical intervention due to the intensity of their activity.
Type IV, V, and VI AC Joint Injury Treatment
Treatment for Type IV, V, and VI AC joint injuries generally includes surgery to realign and attach the damaged or torn ligaments and hold the clavicle in place as it heals. There are many types of both open and arthroscopic surgery procedures that can be used to repair a separated shoulder.
The goal of all these is to align and stabilize the clavicle in position and reconstruct the damaged ligaments. In such procedures, the clavicle is held in position with sutures or metal screws while the ligaments heal.
Most shoulder separations heal within two to three months with no complications.