Separated Shoulder

What is a separated shoulder?

A separated shoulder occurs when the ligaments between the collarbone (clavicle) and part of the shoulder blade (acromion) are torn. The tear loosens the joint connection between the collarbone and shoulder blade, causing them to separate or move apart from one other. A separated shoulder does not actually involve damage to the main ball-and-socket joint of the shoulder.

Other names for this condition are acromioclavicular joint separation or AC joint separation. These names reflect the medical references for the collarbone (clavicle), and the outer end of the scapula (acromion) that extends over the shoulder joint at its highest point.

Who is affected by a separated shoulder?

A separated shoulder can affect anyone regardless of age, ethnic background, physical health or level of fitness.

What causes a separated shoulder?

Most shoulder separations are caused by falling directly onto the shoulder with enough force to tear ligaments. Besides falls, car accidents and sports injuries are frequent causes.

What are the symptoms of a separated shoulder?

• Pain at the very top of the shoulder.
• A bump on the top of the shoulder at the end of the collarbone. As a result of torn ligaments, the shoulder blade moves downward from the weight of the arm, causing the top end of the collarbone to protrude up.

How is a separated shoulder diagnosed?

• Review of current symptoms and appearance of the injured shoulder.
• Review of medical history.
• A physical examination.
• Imaging tests such as X-rays, ultrasound and MRI (magnetic resonance imaging). The patient may be asked to hold a weight in the hand during these tests to make the injury stand out more on the images that are captured.

After an examination, the doctor can make a determination of the seriousness of the 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 the patient an idea of how long treatment could last and what long-term effects might occur.

How is a separated shoulder treated?

Most people will recover from a separated shoulder within two to 12 weeks without surgery. Non-surgical treatments include the following:

• Use of a sling to keep the shoulder in place while healing.
• Ice packs and medications such as ibuprofen, naproxen, aspirin or acetaminophen to reduce pain.
• Physical therapy or an exercise program to strengthen the muscles and ligaments of the shoulder once it has healed. A doctor’s approval should be received before starting a rehabilitation program.
• Avoidance of lifting heavy objects for eight to 12 weeks after the injury has healed.

Surgery may be required in more serious cases (such as a type IV, V or VI injuries on the Rockwood scale) or after determining that non-surgical treatments are not the best option. More serious injuries are indicated when the fingers are numb or cold, arm muscles are weak, or deformity of the shoulder is severe. Surgical treatments include:

• Shaving the end of the collarbone to prevent it from rubbing against the shoulder blade.
• Reattaching torn ligaments to the underside of the collarbone. This surgery can be performed even long after the injury has occurred, but may require a graft tissue to help reconstruct the ligaments if a lot of time has passed since the injury.

What are the complications associated with a separated shoulder?

Although most people regain complete function of the 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 bones of the shoulder joint.

Can a separated shoulder be prevented?

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

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

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