Shoulder Separation: An AC Joint Injury (Video)

A shoulder separation, also known as an acromioclavicular separation or AC joint separation, is a common and painful injury. Fortunately, the AC joint usually heals without surgery. Let’s examine what it is, how it occurs, and the best treatment methods.

AC Joint Anatomy

The acromioclavicular (AC) joint is at the upper end of the collarbone, right at the top of the shoulder. It’s where the collarbone meets the shoulder blade’s acromion. Unfortunately, this joint can cause various shoulder issues.

What Is an Acromioclavicular Joint Separation?

Several associated muscles, ligaments, bones, and other nearby joints support the primary shoulder joint. One of these joints is the AC joint, made up of the acromion (the “A”) and the clavicle, or collarbone (the “C”). This rigid joint is held together by several ligaments on top of the main shoulder joint.

An AC joint separation is just that: a complete or partial separation of the acromion from the outer end of the clavicle at the AC joint. This occurs when the ligaments that hold the joint together are sprained (partially torn) or completely torn.

How an AC Joint Injury Occurs

Most AC injuries occur when someone lands or is struck forcibly on the top or side of their shoulder. Hockey and football players are especially susceptible to these injuries. For example, a quarterback sack can drive a QB’s shoulder into the ground, or a hockey player may be forced into the boards. However, AC joint separations can occur in nearly all sports.

It is important to differentiate between a separated shoulder and shoulder dislocation. While a shoulder separation involves the torn ligaments connecting the collarbone and shoulder blade, shoulder dislocation refers to the actual ball part of the shoulder joint popping out of its socket.

When Should You See a Doctor?

As stated, a fall directly on the shoulders is a common cause of acute AC joint problems. The falls are the start of an acute injury, which, if not promptly addressed, can lead to further shoulder complications. It is important to seek medical attention for any sudden increase in AC joint pain. If the pain is persistent and significant, it may be necessary to consult an orthopedic surgeon for proper treatment.

Long-Term Effects

Although many AC joint injuries do not result in long-term problems, some separations where the bone does not align correctly can lead to arthritis. This condition causes the joint to become swollen, painful, and irregular.

Signs and Symptoms of an AC Shoulder Separation

If you separate your shoulder, you’ll know it right away. These injuries are very painful.

More specifically, you may have a joint separation if:

• You have immediate and significant pain at the top of your shoulder at the AC joint.
• You cannot lift your arm due to the pain.
• You notice swelling at the top of the shoulder.
• You have bruising of the skin around the injured joint.
• You have a deformity at the top of the shoulder; this is usually a noticeable bump in the same area as the pain.
• Your shoulder droops somewhat.

Shoulder separations are graded based on the extent of the ligaments’ injuries and of the injury to the surrounding soft tissues. The severity of the injury guides the treatment recommendations.

Treating Shoulder Joint Separations

Essentially, there are two main types of shoulder separations: those that require surgery and those that don’t. Fortunately, most AC joint separations can be treated without surgery.

Nonsurgical Treatment

Again, most AC injuries do not require surgery. Even if there is a shoulder deformity, the full, pain-free function can usually be regained nonoperatively.

Initial treatment consists of:

• Ice to reduce the swelling and numb the pain
• Pain medications
• Rest, usually with the affected arm in a sling

After one to two weeks, physical therapy is recommended to restore the shoulder’s range of motion, strength, and function. Most can expect significant improvement within two to six weeks with this treatment. However, full recovery for older or more active patients can take two to three months.

Surgical Treatment

AC joint separations rarely need surgery. It is reserved for injuries with significant, specific deformities revealed on radiographs (X-rays).

AC joint surgery is not an emergency treatment. It is best done after the swelling and initial severe pain have improved. The procedure uses tissue from elsewhere in the body to repair or reconstruct torn ligaments. The surgery may also install additional means to properly align the AC joint, including sutures, pins, and screws. Full recovery from surgery can take as long as six months, and most patients need a fair amount of physical therapy to restore pain-free function.

AC separations are common, painful injuries. Fortunately, they can usually be treated without surgery. Because the symptoms of a shoulder separation can be similar to other injuries that may require surgery, request an appointment or call (571) 250-5660 to meet with a Town Center Orthopaedics specialist.