What Is a Shoulder Separation?
A shoulder separation occurs after a fall or a sharp blow to the top of the shoulder. This injury is usually sports related or due to car accidents or falls. This is not the same as a shoulder dislocation, which occurs at the large joint where the arm attaches to the shoulder, although the two may appear similar when the injuries first occur.
The shoulder separation, or acromioclavicular (AC) dislocation, is an injury to the junction between the collarbone and the shoulder. It is usually a soft-tissue or ligament injury but may include a fracture (broken bone). In severe shoulder separations, the coracoclavicular (CC) ligament is also injured.
Depending on the damage done to the joint, there are different classifications (grades) to define the amount of injury:
- Type I: The AC ligament is partially torn, but the CC ligament is not injured.
- Type II: The AC ligament is completely torn, and the CC ligament is either not injured or partially torn. The collarbone is partially separated from the acromion.
- Type III: Both the AC and CC ligaments are completely torn. The collarbone and the acromion are completely separated.
- Types IV through VI: These are uncommon injuries and involve tearing of the muscles across the shoulder and neck.
What Causes a Shoulder Separation?
A shoulder separation occurs when a sharp blow or a fall causes the collarbone (clavicle) to be forced away from the bone of the shoulder (the acromion of the scapula). Usually a sports injury, a shoulder separation is more common in contact sports such as football, rugby, hockey, or wrestling. A car accident or a fall may also cause this injury.
What Are Risk Factors for a Shoulder Separation?
Some risk factors for shoulder separation include the following:
- Participation in contact sports, such as football, ice hockey, or rugby
- Participation in sports where falls are more common, such as downhill skiing, cycling, or gymnastics
- Gender: Males are more likely to have a shoulder separation than females.
- Age: Teenagers and young adults have this injury occur more often. This is thought to be due to younger people participating in more rigorous sports.
- Anatomy: weak shoulder muscles, shallow joint sockets, and loose ligaments
- Previous shoulder separation
What Are Shoulder Separation Symptoms and Signs?
The following signs and symptoms are associated with a shoulder separation.
- Pain to the top of the shoulder: Often, it is most comfortable to support the affected arm with the opposite hand.
- Swelling, cuts, or bruises may be present on the top of the shoulder.
- An obvious upward pointing lump on the top of the shoulder is seen in more serious separations. This is the end of the displaced collarbone (the clavicle bone), and it moves up if the affected arm is pulled toward the ground.
- Tenderness or soreness is felt at the junction, or joint, between the collarbone and shoulder. Tenderness is felt at the site of the AC (acromioclavicular) joint.
- If nerve damage occurs, numbness or muscle weakness may be present in the shoulder or affected arm. If this symptom occurs, seek immediate medical attention.
- In severe cases, there will be limited movement of the shoulder.
When Should Someone Seek Medical Care for a Shoulder Separation?
It is often difficult to tell a moderately severe shoulder separation from a fracture of one of the shoulder bones, an injury in the rotator cuff, a torn labrum (ligaments that hold the shoulder in place), or a dislocation of the shoulder (in which the bone in the upper arm [humerus] comes out of the shoulder joint).
Signs of a severe shoulder separation include severe pain, limited range of motion, popping sensation with slight motion, and cold or numb fingers.
Because some cases of severe shoulder injury may give you only mild pain with a slight decrease in mobility, people with a shoulder injury often need physician's examination and an X-ray.
Mild tenderness to the top of the shoulder may be consistent with minor bruising. If these symptoms go away with ice, acetaminophen (Tylenol), or ibuprofen (Motrin), this injury is unlikely to produce serious or chronic problems.
Severe pain, cold or numb fingers, severe or persistent decreased range of motion, and deformity of the shoulder indicate the presence of a potentially serious shoulder injury. If these signs and symptoms are present, go to the hospital's emergency department for prompt diagnosis and treatment.
What Specialists Treat Shoulder Separation?
You may initially be diagnosed with a shoulder separation by your primary-care provider (PCP) such as a family practitioner, internist, or a child's pediatrician. You may also see an emergency-medicine specialist in a hospital's emergency department.
You will likely be referred to an orthopedist, which is a physician who specializes in disorders of the musculoskeletal system. If you need surgery, you may see an orthopedic surgeon.
Physical therapists may also be a part of a treatment plan for separated shoulder.
How Do Health-Care Professionals Diagnose a Shoulder Separation?
The diagnosis for shoulder separation is made based on a careful history and physical examination. X-rays are usually taken. The doctor may order X-rays with the patient holding weights to pull down on the shoulder joint to see if a shoulder separation is present.
Other injuries to the joint, muscles, and bone may require other tests such as an ultrasound or MRI. These are almost never ordered as part of the initial evaluation because the initial treatment plan may not change based on the results.
Are There Home Remedies for a Shoulder Separation?
Like other problems with bones and joints, the first priority is to prevent further harm and ease the pain by immobilizing the joint and applying ice.
- Shoulder slings are perfect for immobilization.
- The application of ice helps decrease the swelling to the area. This decreases pain and expedites recovery.
- An effective home ice pack can be made by filling a large storage-size plastic bag with crushed ice. Place a towel or washcloth over the bag, and apply to the top of the shoulder. Frozen bags of vegetables, such as peas, can also be used as ice packs as they will conform to the shape of the shoulder.
- The ice pack should be removed if the skin is completely numb or if you sense a burning or pins-and-needles feeling. After allowing the skin to rewarm for 10-15 minutes, the ice may be reapplied.
- Ice should be applied for 15 to 20 minutes every hour, as often as can be tolerated.
- Ice should be used for the first 48 hours of most shoulder separations.
- Acetaminophen (Tylenol) or ibuprofen (Motrin) or similar medications can be given for pain and swelling.
What Is the Treatment for a Shoulder Separation?
- Ice is an important treatment for most acute soft-tissue injuries.
- Frequently, a sling is needed and helpful for the first few days after an injury. This helps to support the weight of the arm and to restrict motion. A doctor may advise some motion exercises such as stretching and light weight-bearing within a few days once the immediate pain has stopped.
- Pain relievers and anti-inflammatory medications may be advised, either over the counter or by prescription.
- Physical therapy may be required, particularly once the immediate pain has stopped within a few days. The decision to prescribe rehabilitation therapy often is made during a follow-up visit.
- Complete ligament rupture at the AC joint may require surgical repair. The surgery can be done with an open incision or arthroscopically (with a small camera and small incisions).
- The Weaver Dunn procedure is a surgical intervention used to repair a severely damaged AC joint separation.
Follow-up for a Shoulder Separation
A doctor may recommend follow-up care. Possibly, no follow-up care may be needed. From that visit, determinations regarding referrals for physical therapy or further orthopedic consultation may be made.
What Is the Prognosis for a Shoulder Separation?
The prognosis for simple separations is generally good if there is just a strain and the ligaments are not greatly damaged. Recovery time depends on the extent of the injury. More serious ligament damage, especially in athletes and people who depend on their arms for work, may require surgery and physical therapy to return to baseline functioning.
Some people will have complications, including frustrating pain, arthritis, frozen shoulder, and decrease in mobility despite therapy, though the vast majority of people will recover to full function within a few weeks.
Is It Possible to Prevent a Shoulder Separation?
Prevention of shoulder separation involves wearing proper protective equipment when participating in sports, making sure shoulder muscles are well-conditioned and strong, and preventing falls. If any activity causes shoulder pain, stop and see a doctor before the condition gets worse. If there is a pre-existing shoulder injury, do rehabilitation exercises and allow the injury to heal completely.
Shoulder Separation Pictures
The patient's right shoulder (viewer's left) is separated. Photo courtesy of Lisa Chan, MD, Department of Emergency Medicine, University of Arizona College of Medicine. Acromioclavicular joint separation. X-ray courtesy of Lisa Chan, MD, Department of Emergency Medicine, University of Arizona College of Medicine.