Separated Shoulder

What is a separated shoulder?

A separated shoulder is an injury to your acromioclavicular joint, which is the area where your collarbone (clavicle) meets the highest point of your shoulder blade (acromion). A shoulder separation doesn’t actually involve damage to the main ball-and-socket joint of your shoulder.

An injury to your acromioclavicular joint occurs when the ligaments between your clavicle and acromion tear or stretch too much. The tear loosens the joint connection between your collarbone and shoulder blade, causing them to separate or move apart from one another.

Other names for this condition are acromioclavicular joint separation or AC joint separation.

How common is this condition?

Studies show that acromioclavicular joint injuries may be the cause of as many as 40% of all shoulder injuries. They account for 9% of all injuries involving collision sports like football, lacrosse and hockey.

What are the symptoms of a shoulder separation?

Separated shoulder symptoms vary depending on the extent of your injury. They can be mild to severe and may include:

• Pain at the very top of your shoulder.
• A bump on the top of your shoulder at the end of your collarbone. As a result of torn ligaments, your shoulder blade moves downward from the weight of your arm, causing the top end of your collarbone to protrude up.
• Limited movement in your shoulder area.
• Swelling and tenderness.
• Bruising.

What causes shoulder separations?

Falling directly onto the outside of your shoulder with enough force to tear the ligaments is a common cause of shoulder separations. This can happen due to falls, car accidents or sports injuries. An example is a football wide receiver making a diving catch, landing hard and sliding on the outside of their shoulder, and forcing their arm down.

What are the complications associated with a separated shoulder?

Although most people regain complete function of their injured shoulder, sometimes a bump or other deformity remains. There may also be continued pain, even in what appears to be a mild shoulder separation. This can be the result of bones rubbing against one another, arthritis or damage to the cartilage which provides a cushion between the bones of your shoulder joint.

How is a shoulder separation diagnosed?

Your healthcare provider will review your current symptoms and medical history and perform a physical examination. Your provider may have you hold a weight in your hand to see if your clavicle sticks out.

Depending on the extent of your injury, your provider may also order imaging tests, including:

• Shoulder X-ray.
• Ultrasound.
• Magnetic resonance imaging (MRI).

Your provider may ask you to hold a weight in your hand during these tests to make the injury stand out more on the images they capture.

After the examination and imaging, your provider may refer you to an orthopedic surgeon (orthopedist). An orthopedist can determine the seriousness of your shoulder separation using a scale such as the Rockwood classification of AC joint injuries. This scale ranges from type I (injury limited to an AC ligament sprain; joint still in place) to VI (severe ligament detachment and joint dislocation) injuries. The rating helps determine the appropriate medical response, including the need for surgery, and gives you an idea of how long treatment could last and what long-term effects might occur.

Grades of shoulder separation

A shoulder separation can be mild to severe. Healthcare providers classify acromioclavicular joint separations based on the extent of your injury and how many ligaments are involved. Providers frequently use a rating system called the Rockwood classification of AC joint injuries, which includes:

• Type I: Your injury involves a sprain or partial tear of your acromioclavicular (AC) ligaments with no injury to additional ligaments that stabilize your clavicle, called coracoclavicular (CC) ligaments. You may have mild swelling and tenderness, but it should heal on its own within a few weeks.
• Type II: Your injury involves a complete tear of your AC ligaments and a sprain or partial tear of your CC ligaments. You may have mild tenderness and significant swelling.
• Type III: Your injury involves a complete tear of your AC and CC ligaments. Your AC joint may have a large bump but also have significant swelling, and your CC joint will be very tender.
• Type IV: Your injury involves torn ligaments, and your clavicle is pushed back behind your acromioclavicular joint. This is a fairly severe injury that may need surgery.
• Type V: Your injury involves torn ligaments, and the end of your clavicle punctures the muscle above your acromioclavicular joint. This is another severe injury that may require surgery.
• Type VI: Your injury involves torn ligaments, and your clavicle pushes downward and becomes lodged underneath your coracoid (part of your shoulder blade). This is a rare yet severe injury that requires surgery.

How is a separated shoulder treated?

Most people will recover from a separated shoulder within two to 12 weeks without surgery. Nonsurgical separated shoulder treatment includes the following:

• Use of a sling to keep your shoulder in place while healing.
• Ice packs and medications such as NSAIDs (nonsteroidal anti-inflammatory drugs, like ibuprofen and naproxen), aspirin or acetaminophen to reduce pain.
• Physical therapy or an exercise program to strengthen the muscles and ligaments of your shoulder once it’s healed. You should receive your orthopedic surgeon’s approval before starting a rehabilitation program.
• Avoidance of lifting heavy objects for eight to 12 weeks after your injury has healed.

You may need surgery in more serious cases (such as a type IV, V or VI injuries on the Rockwood scale) or after determining that nonsurgical treatments aren’t the best option. More serious injuries are indicated when your fingers are numb or cold, your arm muscles are weak or the deformity of your shoulder is severe. Surgical shoulder separation treatment includes:

• Shaving the end of your collarbone to prevent it from rubbing against your shoulder blade.
• Reattaching torn ligaments to the underside of your collarbone. Providers can perform this surgery even long after the injury has occurred. But it may require a graft tissue to help reconstruct the ligaments if a lot of time has passed since your injury.

Can a separated shoulder be prevented?

While there’s no sure way to prevent a separated shoulder, it’s helpful to be aware of the factors that increase the chances of shoulder injuries. These factors can include:

• Repetitive motions with your shoulder.
• Aging.
• Overuse or straining of your shoulders, particularly in people age 65 and older.
• Manual labor.
• Participation in sports involving collisions with others or the ground.
• Accidents and falls.

What can I expect if I have a separated shoulder?

You can expect to have some pain and swelling, especially with more severe types of injuries. The good news is that the outlook (prognosis) for most acromioclavicular joint injuries is generally favorable.

Most shoulder separation injuries require nonsurgical treatment. Your separated shoulder recovery time may take a few days to less than six weeks for a mild injury. You should be able to return to all normal activities within three months, depending on the extent of your injury.

If your shoulder separation requires surgery, your recovery may take longer. You may not be able to use your shoulder for six weeks. You’ll be able to gradually return to normal activities in about six months.

How do I take care of myself?

There are exercises you can do to help your shoulder get better. Talk with your orthopedic surgeon before starting any shoulder exercises.

Range-of-motion exercises

Range-of-motion exercises can help you maintain joint mobility and help keep your shoulder muscles and tendons flexible. These exercises include the pendulum stretch and wall climbing, which you should try to perform once or twice a day for five minutes.

Pendulum stretch

1. Relax your shoulder muscles.
2. While sitting or standing, keep your arm vertical and close to your body.
3. Let your arm swing forward to back, and then side to side. Then, let your arm swing in small circles.
4. Begin without weights for three to seven days, and then gradually add 1- to 2-pound weights to the exercise each week. You can also gradually increase the diameter of your circle movements over time.

Wall climbing

1. Use your good arm to lift your injured hand onto the wall.
2. Use your fingers to walk up the wall.
3. Use your other hand and your body to gently assist this maneuver.
4. Hold for 30 seconds, then relax. Repeat a total of four times, trying to move higher each time.

Muscle-strengthening exercises

Muscle-strengthening exercises can help you improve your shoulder muscle strength and prevent further injury. You can often start these exercises one to two weeks after beginning the pendulum stretch exercise. Muscle-strengthening exercises include scapular squeezes, which you should try to perform two to three times a day.

1. Lay on your back with your knees bent and your feet flat on the floor.
2. Place your arms straight out with your palms facing up, 6 to 12 inches away from the side of your body.
3. Squeeze your shoulder blades down and toward each other — toward your spine, making sure to keep your lower back flat against the ground.
4. Hold for five seconds and repeat the exercise 20 times.

Try to keep your neck relaxed, and don’t shrug your shoulders. You should be able to feel the lower muscles between your shoulder blades contracting.

When should I see a healthcare provider about a separated shoulder?

The presence of any of the following symptoms after a shoulder injury requires medical attention:

• Severe pain.
• Weakness in your arm or fingers.
• Numb or cold fingers.
• Difficulty in moving your arm through a normal range of motion.
• A lump on top of your shoulder, making it look deformed.

What questions should I ask my healthcare provider?

If you have a separated shoulder, you may want to ask your provider the following questions:

• What type or grade of shoulder separation do I have?
• What kind of treatment do you recommend?
• What can I do at home to help with my recovery?
• How long will it take to recover from this injury?
• How can I prevent separating my shoulder again?

What’s the difference between a separated shoulder and a dislocated shoulder?

A separated shoulder is a ligament injury involving your acromioclavicular joint, the point where your clavicle meets the highest part of your shoulder blade.

A shoulder dislocation involves your glenohumeral joint, which is the point where your arm bone (humerus) meets your shoulder joint. This injury occurs when your humerus ball comes out of your shoulder socket.