A separated shoulder, not to be confused with shoulder dislocation, often occurs during a fall on the apex or tip of the shoulder. This results in a tear of the ligaments that holds the collarbone to the top of the shoulder, known as the AC Joint (AcromioClavicular Joint). This type of injury is a ligament sprain, meaning that it varies by grade.

What is a Separated Shoulder?

A separated shoulder or acromioclavicular (AC) joint separation is an injury where the ligaments connecting the collarbone (clavicle) to the shoulder blade (scapula) are damaged or torn. This injury, often referred to as an AC separation shoulder, typically results from falls or direct hits to the shoulder.

It’s important to note that a separated shoulder differs from a dislocated shoulder. Both involve harm to the shoulder joint, but they affect different parts. A separated shoulder involves the AC joint, located where the collarbone meets the shoulder blade. Conversely, a dislocated shoulder occurs when the upper arm bone (humerus) slips out of the shoulder socket.

If you suspect you have a separated shoulder or an AC injury, seek immediate medical attention for a precise diagnosis and appropriate shoulder separation treatment. Here at JOI Online, our skilled orthopedic specialists are ready to provide expert care and guide you through your recovery journey.

Severity of the sprain is based on the level of disability following the injury. Minor symptoms can occur, such as soreness or a small bump located in the area.  More serious injuries can result in loss of range of motion or lack of strength in the shoulder. In many cases, X-rays can only show evidence of more severe, or Grade Three, separations.

Recognizing Symptoms and Causes

Understanding the signs and causes of a separated shoulder or acromioclavicular AC joint separation can lead to an accurate diagnosis and effective treatment. Here are common symptoms and types of shoulder separations, along with their causes.

Common symptoms include:

• Pain and tenderness at the shoulder’s top
• Swelling and bruising
• Difficulty moving the arm and shoulder.
• A visible bump or deformity at the injury site

Shoulder separations vary in severity, with the most common being an acromioclavicular separation, where the collarbone separates from the shoulder blade. Another type is a sternoclavicular (SC) joint separation, where the collarbone separates from the breastbone.

Causes are often related to sports or high-impact activities. Falls, direct impacts on the shoulder, or landing on an outstretched hand can result in this injury. Athletes engaged in contact sports like football or hockey are particularly susceptible to AC joint separations.

Unlike many shoulder dislocations that require surgery to repair the injury, there are few cases of surgical intervention for shoulder separation. Treatment is generally conservative with short- term immobilization, ice, physical therapy, and exercise. In fact, many studies have shown that such conservative treatment and surgery essentially have the same results one year after a

shoulder-separation injury.

In sports like football, the AC Joint is protected after an injury with padding to protect it from contact.  Special shoulder pads can also be used to protect the AC Joint.

Diagnosis and Testing

Diagnosing a separated shoulder or an acromioclavicular joint separation involves a combination of a physical examination and imaging tests. These methods allow physicians to differentiate an AC separation from other shoulder injuries, ensuring the appropriate shoulder separation treatment is provided.

During a physical examination, the healthcare provider checks for deformity, swelling, and tenderness. They may evaluate the shoulder joint’s range of motion and strength. By touching the area and eliciting specific movements, they gather vital information about the AC injury.

Imaging tests, such as X-rays, confirm the diagnosis and determine the injury’s severity. In some instances, a stress x-ray might be performed to assess stability, and an MRI scan may be ordered to provide detailed images of the soft tissues. This comprehensive view of the injury aids in differential diagnosis, ruling out conditions that may present with similar symptoms, such as shoulder dislocations, clavicle fractures, or rotator cuff injuries.

Treatment and Management

Various treatment options are available for a separated shoulder or AC separation, depending on the injury’s severity. Mild to moderate AC injuries typically require non-surgical treatments, while severe cases may necessitate surgical intervention for shoulder separation treatment.

Non-surgical treatment often involves conservative management, including rest, ice, compression, and elevation (RICE), and using a sling or shoulder immobilizer. Pain medications may also be prescribed to alleviate discomfort and reduce inflammation.

Physical therapy is crucial to recovery from an AC injury or acromioclavicular separation. A therapist can guide patients through exercises to strengthen muscles, improve range of motion, and restore full shoulder function. These exercises progress from gentle stretching to advanced strengthening exercises.

In severe cases, surgical intervention may be necessary. Surgical options may include arthroscopic surgery or open reduction internal fixation (ORIF), which realigns and stabilizes the separated shoulder using screws, plates, or pins.

After shoulder separation treatment, whether non-surgical or surgical, rehabilitation is essential for optimizing outcomes. The rehabilitation process involves exercises supervised by a physical therapist to restore strength, stability, and function to the shoulder. The duration of rehabilitation may vary, but typically involves stretching, strengthening, and functional exercises.

Preventing Shoulder Separations

Prevention is always better than cure. Here are some tips to prevent a separated shoulder or acromioclavicular AC joint separation:

1. Maintain proper posture and body mechanics to reduce unnecessary stress on the shoulders.
2. Regularly perform exercises targeting the shoulder joint muscles to improve stability.
3. Always warm up properly before engaging in any high-risk activities or sports.
4. Use protective gear and equipment when participating in high-risk activities or contact sports.

By adopting these preventive measures, you can significantly reduce the chances of experiencing an AC separation shoulder. However, if you do sustain an AC injury, seek medical attention promptly to receive appropriate shoulder separation treatment and ensure proper healing.

JOI & JOI Rehab 

JOI Physicians are Northeast Florida’s most respected orthopedic practice.  With over 20 orthopedic physicians that treat the shoulder and injuries to the shoulder. For more information on shoulder separations, click here to watch a video provided by JOI physician Dr. Crenshaw. You can also visit JOIONLINE.NET, schedule online or call 904-JOI-2000

If you are interested in scheduling an appointment at JOI Rehab for physical therapy, call (904) 858-7045

To read more about the shoulder, please read the 3 top shoulder exercises and stretches for shoulder pain.

If you have recently had a shoulder surgery, please watch this helpful video: Dressing the Upper Body After an Injury or Surgery

By: Tim Wall, MS, ATC