Shoulder Separation

These articles are for general information only and are not medical advice. Full Disclaimer. All articles compliments of the AAOS.


Description

A shoulder separation is not truly an injury to the shoulder joint. The injury actually involves the acromioclavicular joint (also called the AC joint). The AC joint is where the collarbone (clavicle) meets the highest point of the wingbone (acromion).

Figure 1: Normal Shoulder

Mechanism of Injury

Figure 2: Ligaments Around AC Joint

The most common cause for a separation of the AC joint is from a fall directly onto the shoulder. The fall injures the ligaments that surround and stabilize the AC joint.

If the force is severe enough, the ligaments attaching to the underside of the clavicle are torn. This causes the “separation” of the collarbone and wingbone, the wingbone actually moves downward from the weight of the arm. This creates a “bump” or bulge above the shoulder.

The injury can range from a little change in configuration with mild pain, to quite deforming and very painful. Good pain-free function often returns even with a lot of deformity. The greater the deformity, the longer it takes for pain-free function to return.

  • A mild shoulder separation involves a sprain of the AC ligament that does not move the collarbone and looks normal on X-rays.
  • A more serious injury tears the AC ligament and sprains or slightly tears the coracoclavicular (CC) ligament, putting the collarbone out of alignment to some extent.
  • The most severe shoulder separation completely tears both the AC and CC ligaments and puts the shoulder joint noticeably out of position.

Diagnosis

The injury is easy to identify when it causes deformity. When there is less deformity, the location of pain and X-rays help the doctor make the diagnosis. Sometimes having the patient hold a weight in the hand can increase the deformity, which makes the injury more obvious on X-rays.

Treatment Options

Nonsurgical treatments such as a sling, cold packs and medications can often help manage the pain. Sometimes a doctor may use more complicated supports to help lessen AC joint motion, reduce the deformity and lessen pain.

Most people return to near full function with this injury, even if there is a persistent, significant deformity. Some people have continued pain in the area of the AC joint even with only a mild deformity. This may be due to:

  • Abnormal contact between the bone ends when the joint is in motion
  • Development of arthritis
  • Injury to a disk-like piece of cushioning cartilage that is often found between the bone ends of this joint

It is worthwhile to wait and see if reasonable function returns without surgical treatment.

Treatment Options: Surgical

Surgery can be considered if pain persists or the deformity is severe. A surgeon might recommend trimming back the end of the collarbone so that it doesn’t rub against the AC. Where there is significant deformity, reconstructing the ligaments that attach to the underside of the collarbone is helpful. This type of surgery works well even if it is done long after the problem started.

Whether treated conservatively or with surgery, the shoulder will require rehabilitation to restore and rebuild motion, strength and flexibility.


Maintained and hosted by Medical Informatics Solutions LLC

OUR SUBSIDIARIES & AFFILIATES

Orthopedics & Sports Medicine

Our highly experienced and regarded orthopedic surgeons specialize in the diagnosis and treatment of disorders that affect bones, joints, muscles, cartilage, ligaments and nerves of the extremities and spine. They are proud to be affiliated with both St. Mary Mercy Hospital and St. John Macomb Hospital..

Back, Neck & Spine

You’ll have the advantage of the latest surgical and non-surgical procedures in back and neck pain. A team approach to your spinal problems may include physical therapy, medication, exercise, weight loss and therapeutic spinal injections. Additionally, we offer the area’s best orthopedic spine surgeons for repair or reconstruction of structural disorders.

Pain Management

The pain management / physical medicine and rehabilitation physicians at Mendelson Kornblum have a tremendous amount of experience and knowledge regarding pain-relieving techniques and treatments. Areas of specialty include back pain, neck pain, herniated discs, pinched nerves, post-surgical pain, cancer-related pain, musculoskeletal injuries, and rehabilitation for back and neck injuries. If you have acute or chronic pain that affects your mobility and ability to function, Mendelson Kornblum Orthopedics can help restore your quality of life.

Physical Therapy

Our rehabilitation approach complements your surgeon’s intervention with continual sharing of diagnostic information that can help promote a speedy recovery. In addition, due to our exclusive dedication to orthopedic conditions, we have developed many techniques that can significantly reduce the amount of pain during your rehabilitation.