Separated Shoulder
Quick Reference
Reviewed by Dr. Peter Simonian
(Also known as Acromioclavicular Joint or AC Joint Separation)
The shoulder is the junction of three bones: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone). A shoulder separation involves the first two bones: the clavicle and the scapula. The tip of the scapula is known as the acromion, and forms the roof of the shoulder. The acromion and clavicle meet in a joint known as the Acromioclavicular (AC) Joint, and are held fast by ligaments. Ligaments exist in two places in the joint: one group surrounds the joint, and another holds the clavicle down, anchoring it to a knob on the scapula known as the coracoid process. A separated shoulder occurs when the ligaments between the acromion and the clavicle weaken, sprain or tear. The injury may occur in one of six degrees, or grades, of severity:
- Grade 1: Mild sprain of the Acromioclavicular (AC) joint capsule – where the ligaments surrounding the joint suffer a minor sprain, resulting in pain and stiffness. Treatment is RICE and rehabilitation.
- Grade 2: Moderate sprain with a tear of the AC joint and a partial tear of coraco-clavicular (CC) ligaments. This injury causes a slight elevation of the clavicle (actually a drop of the humerus) and results in greater pain (than in Grade 1) and loss of shoulder mobility. Treatment is RICE and rehabilitation.
- Grade 3: Severe sprain with tear of both the AC joint and the CC ligaments. The clavicle appears to be elevated 1 width above the joint, and there is a visible bump on the shoulder. Treatment depends on which shoulder is injured (i.e., is it the patient's dominant side? Is the patient involved in physical activities?) The injury can be treated well with either RICE and rehabilitation, or surgery to stabilize the shoulder. The shoulder can also be stabilized later with surgical reconstruction.
- Grade 4: The clavicle is displaced posteriorly into the trapezius muscle. Surgery is usually needed.
- Grade 5: The clavicle is displaced upwards, more than a grade 3 separation. Surgery is usually needed.
- Grade 6: The clavicle is displace under the Coracoid Process. Surgery is needed.
Detailed Description
Symptoms
Stiffness and tenderness around the joint generally characterize low-grade AC Joint separation. Increased pain, tenderness, swelling, bruising, or redness marks a Grade-2 or -3 separation. In a grade-3 separation, a popping sound is heard at the time of injury. If the shoulder has completely separated, a bump on the shoulder will be quite noticeable.Causes and Risk Factors
Causes
Patients who separate their shoulders generally do so by falling onto the joint. The fall usually jolts the shoulder blade downward, creating great pressure on the joint. Since the collarbone is affixed to the rib cage, the weakest link in the AC joint—the ligaments—become weakened or torn, causing the joint to lose stability. Risk Factors
AC Joint separation is an acute injury most often caused by a severe hit to the shoulder, whether by falling upon it, or being dealt a blow by another person or hard object.
Treatment
Immediate Action:
If the injury is extremely painful, was accompanied by a noticeable popping sound, or produced a visible bump in the mid-shoulder, see a doctor immediately. Apply ice to the shoulder to reduce swelling and take over-the-counter anti-inflammatory drugs, such as ibuprofen or acetaminophen unless an existing condition prohibits it. A sling or bandage to support the arm may provide comfort. After 24 hours, apply heat to the area with a heating pad or a hot compress.See your doctor...
If the pain is greater than you can bear or is not reduced after 24 hours.Procedures
A doctor will most likely order a sling and anti-inflammatory drugs while the AC joint ligaments heal. In some severe cases, or with high-performance athletes, a doctor may deem surgery necessary. The procedure re-sets the clavicle and acromion in place and repairs the ligaments.
Medications
Include prescription and non-prescription anti-inflammatory and pain-killing drugs.Prevention
Because an AC Joint separation is generally caused by an acute blow to the shoulder, avoid falling on the shoulder or engaging in activities that put the shoulder at risk of a hard hit.
Last updated: 10-Oct-00
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