Shoulder (AC) Separation

An acromioclavicular joint separation (AC separation), or shoulder separation, is a very frequent injury among active people, especially football or hockey players, and cyclists who fall over their handlebars. This injury occurs when the collarbone (clavicle) separates from the shoulder blade (acromion). In most cases, shoulder separation can be remedied without surgery, but there are certain situations where surgery may be necessary.

Overview

Shoulder separation does not refer to a true injury to the shoulder joint. The injury actually involves the acromioclavicular joint where the collarbone and shoulder blade meet. The most common cause of shoulder separation is due to a direct fall onto the shoulder that injures the ligaments surrounding the AC joint. If the impact was severe, the ligaments attaching the collarbone are torn, which causes the separation. This specific injury can range from mild pain to debilitating pain, depending on the severity of the torn ligaments. A mild shoulder separation refers to a sprain of the AC ligament that is unable to move the collarbone and appears normal on x-rays. A more serious shoulder separation involves a tear of AC ligament and a sprain of the coracoclavicular (CC) ligaments, which forces the collarbone out of alignment. In the most severe cases, the impact completely tears both the AC and CC ligaments, which makes the AC joint noticeably out of place.

If the impact was severe, the ligaments attaching the collarbone are torn, which causes the separation. This specific injury can range from mild pain to debilitating pain, depending on the severity of the torn ligaments. A mild shoulder separation refers to a sprain of the AC ligament that is unable to move the collarbone and appears normal on x-rays. A more serious shoulder separation involves a tear of AC ligament and a sprain of the coracoclavicular (CC) ligaments, which forces the collarbone out of alignment. In the most severe cases, the impact completely tears both the AC and CC ligaments, which makes the AC joint noticeably out of place.

Symptoms

Depending on the severity of your condition, symptoms may vary. Here are some common symptoms involved with all cases of shoulder separation:

• Mild, Grade I Separation: tenderness and bruising of the joint, mild pain when moving the arm.
• Moderate, Grade II Separation: moderate to severe pain at the joint, swelling, small bump on top of shoulder, tenderness to the touch.
• Severe, Grade III Separation: pain with any arm motion, cannot support arm by itself, popping sounds, swelling, AC joint is very unstable, bump on the top of the shoulder.

Treatment

During your evaluation, Dr. Hackett may be able to identify a shoulder separation if there is a deformity, or bump on the top of your shoulder. However, X-rays can help the diagnosis and rule out any other injuries you may have. Based on your evaluation in Vail, Colorado, Dr. Hackett will determine a treatment that is best suited for your injury and lifestyle.

Non-Surgical Treatments

In most cases, non-surgical treatments including a sling, ice packs, and medication can be successful in treating shoulder separation. Sometimes, Dr. Hackett may use more complex supports to restrict the joint motion and reduce pain. Physical therapy plays a key role in non-surgical treatments of shoulder separation, which focus on restoring motion and strength to the AC joint. Depending on your natural healing capabilities and the severity of your injury, most patients heal within three months without surgery. In all cases, it’s worthwhile to wait to see how effective non-surgical treatments work for you without resorting to surgical procedures.

Surgical Treatments

Surgery may be necessary for patients that do not respond well to non-surgical treatments. If the pain persists in the AC joint about three months after starting physical therapy, Dr. Hackett may recommend surgery. In some cases, he may recommend surgery earlier if you are a young, active individual, athlete, or laborer who is required to do overhead work.

Distal Clavicle Resection – The most common surgery performed involves restoring the CC ligaments and removing the distal, or shoulder, end of the collarbone (clavicle). Dr. Hackett commonly utilizes a screw or suture loop to stabilize the AC joint. During a distal clavicle resection, about 10 millimeters of the collarbone is removed. Then the AC ligament is transferred from the bottom of the shoulder blade into the removed end of the collarbone to replace the torn ligament.

Physical Therapy

After surgery, patients can expect to wear a sling for about four weeks and lower arm exercises may begin immediately after the two to three weeks immobilization. Most rehabilitation programs will begin after the sling is removed and will at least 6 to 8 weeks to regain full motion of the shoulder.