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Question:
Hi,
I know you answered a question about a 2nd degree shoulder seperation already but, I've recently seperated my shoulder. The Doctor said it was a 3rd degree seperation. After about 4 months there is still some soreness. The other thing that concerns me is that if I use my other hand, I can move my collar bone up and down. Should I be concerned about this?
Question submitted by:
devon_jr@yahoo.com
| Dr. Bailie |
Dr. David S. Bailie chairs the Department of Orthopedic Surgery at Scottsdale Healthcare Shea (Hospital) in Scottsdale, Arizona, and he sees patients from all walks of life at The Orthopedic Clinic Association (TOCA) in Scottsdale, Arizona. A graduate of the University of Michigan, the Indiana University School of Medicine and was a post-graduate fellowship in Sports Medicine and Arthroscopic Surgery at Baylor Sports Medicine Institute in Houston, Texas. , Dr. Bailie specializes in all sports medicine injuries and arthroscopic surgery, including shoulder reconstruction.
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Answer:
Shoulder separations occur in 6 grades:
- 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.
Soreness may persist for up to 1 year and can be treated with injection. If that fails, reconstruction may be needed, especially if the distal clavicle is hyper-mobile.
