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Shoulder separation

​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​A shoulder separation, is an injury where the clavicle (collar bone) separates from the scapula (shoulder blade).

​​​​​​​​​​Shoulder separations​ are acromioclavicular (AC) joint separations.

It is commonly caused by a fall directly on the "point" of the shoulder or a direct blow received in a contact sport. In general, most AC injuries don't require surgery. There are certain situations, however, in which surgery may be necessary. The pain is most severe when the patient attempts overhead movements or tries to sleep on the affected side.

There are a total of six grades of severity of AC separations. Grades I-III are the most common and range from a mild dislocation to a complete separation:

  • Grade I - A slight displacement of the joint. The acromioclavicular ligament may be stretched or partially torn. This is the most common type of injury to the AC joint.
  • Grade II - A partial dislocation of the joint in which there may be some displacement that may not be obvious during a physical examination. The acromioclavicular ligament is completely torn, while the coracoclavicular ligaments remain intact.
  • Grade III - A complete separation of the joint in which there typically is displacement that is obvious during a physical examination. The acromioclavicular ligament and the coracoclavicular ligaments are completely torn.
  • Grades IV-VI are very uncommon and are usually the result of a very high-energy injury such as one that might occur in a motor vehicle accident. Grades IV-VI are all treated surgically.

Treatments

​The treatment of an AC separation depends on the grade of the injury. Grades I - III are usually treated non-operatively. Some patients with grade III AC separations may be candidates for early surgical reconstruction especially if those patients are involved in heavy labor work or regular overhead reaching sports/activities.

Non-Operative

Most Grade I - III AC separations are treated successfully with non-operative treatment including:

  • Ice to reduce pain and swelling
  • Rest and a protective sling until pain subsides (this usually takes about 1-2 weeks)
  • Pain and anti-inflammatory medications
  • A rehabilitation program to restore normal motion and strength is begun as soon as tolerated with gentle exercises and progresses as healing allows

Surgery

Surgery may be necessary for AC separations that do not respond well to non-operative treatment. A variety of surgical methods have been used to stabilize a separated AC joint. The surgical technique most often performed involves the reconstruction of the coracoclavicular ligaments and the removal of the shoulder end of the clavicle.

Preventive Tip

Strengthen wrists and arm, shoulder, neck and back muscles to help protect and decrease stress on your shoulders. Do stretching and range-of-motion exercises for your arms and shoulders. All of this can help prevent shoulder-related problems and injury.

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The Shoulder Quiz

A glenoid labral tear and a torn rotator cuff are just 2 common injuries that can go happen with your shoulders. Can you think of others? Find out how much you know about shoulders by taking this quiz.

1. The collarbone is part of the shoulder joint.
2. The shoulder is one of the most movable joints in your body.
3. A pain in and around the shoulder may mean your have a disease elsewhere in the body.
4. A shoulder is easy to dislocate.
5. Swelling and numbness are 2 symptoms of a dislocated shoulder.
6. A dislocated shoulder must be kept immobile for 3 months.
7. Jobs that require heavy lifting can lead to rotator cuff tears.

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