What Is a Shoulder Separation?

A shoulder separation (image) refers to the stretching or tearing of ligaments where the collarbone (clavicle) meets the shoulder blade (scapula), also called the acromioclavicular or AC joint. If these ligaments partially or completely tear, the clavicle can slip forward and detach from the scapula. A shoulder separation is usually caused by an impact to the front of the shoulder or by falling on an outstretched hand.

Shoulder Separation Symptoms and Signs

Shoulder pain and tenderness are common symptoms of a shoulder separation after a fall or impact. Sometimes there is a small bump on top of the shoulder along with buising and swelling. Signs and symptoms of shoulder joint injuries range from a minor deformity and mild pain, to a very painful and severe deformity.

Shoulder Separation Severity and Type

The severity of the separation is determined by the amount and direction of joint separation and ligament damage that shows up on x-rays. Type I and II AC joint injuries are considered mild and may respond to conservative treatment. In more severe type IV, V, and VI shoulder separation injuries, the supporting ligaments may actually be torn. These injuries are generally treated with surgery.

Shoulder Separation Treatment

Type I and II AC Joint Injury Treatment
Treatment for type I and II AC joint injuries generally includes conservative treatments including:

• Rest to allow the damaged tissues to heal
• Support and slings to take pressure off the joint
• Ice to reduce swelling and inflammation
• Over-the-counter pain and anti-inflammatory medications
• Physical therapy exercises to increase range of motion and strength

Type III AC Joint Injury Treatment
Treating mild to moderate, or type III, AC joint injuries is not as clear. There is some controversy among surgeons as to whether to use conservative treatments or surgery for a type III shoulder separation. Most patients with type III shoulder separations heal well with conservative treatment and return to sports faster than patients who have surgery. In addition, they avoid any risks of surgery. However, some patients may benefit from a surgical procedure. Those patients who are involved in heavy labor or play sports that require frequent overhead motions, such as tennis or baseball, may benefit more from surgical intervention due to the intensity of their activity.

Type IV, V, and VI AC Joint Injury Treatment
Treatment for Type IV, V, and VI AC joint injuries generally includes surgery to realign and attach the damaged or torn ligaments and hold the clavicle in place as it heals. There are many types of both open and arthroscopic surgery procedures that can be used to repair a separated shoulder. The goal of all these is to align and stabilize the clavicle in position and reconstruct the damaged ligaments. In such procedures, the clavicle is held in position with sutures or metal screws while the ligaments heal.

Most shoulder separations heal within two to three months with no complications.

Return to Shoulder Injury List

_Sources

Acromioclavicular Joint Injuries: Diagnosis and Management, R. Simovitch, et al, Journal of the Am. Academy of Orthopaedic Surgeons 2009 17: 207-219.