Shoulder Separation Treatment

We often think of the shoulder as a single body part, but this isn’t exactly true. In reality, the shoulder is a complex structure consisting of different bones, muscles, and ligaments. If even one part of this structure is damaged or moved out of place, the entire shoulder can be compromised. One such condition is shoulder separation, also known as acromioclavicular joint separation.

At Boston Hand to Shoulder, our specialists are able to quickly diagnose shoulder separation and develop a treatment plan that leads to your full recovery.

There are a number of symptoms that can be indicative of a separated shoulder. The most common is pain and tenderness. This will usually be localized to the top of the shoulder, which is where the AC joint is located.

A shoulder separation can also cause physical deformities to appear. A visible, hard bump may appear at the top of the shoulder. Additionally, the shoulder may droop, appearing lower than the shoulder on the uninjured side.

As with most shoulder injuries, reduced mobility is also a common symptom of shoulder separation. It becomes extremely difficult, or even impossible, to lift the arm. The arm is also likely to feel extremely weak.

Finally, you may hear a popping or grinding noise originating from the AC joint. This will usually occur when making movements that cause the arm to rotate in the shoulder joint.

If you are experiencing these symptoms, it is quite possible that you have a separated shoulder. A doctor should be seen immediately to confirm this.

Unlike many shoulder conditions, shoulder separation is not caused by overuse. Instead, it is almost always caused by direct trauma to the AC joint. Such traumas include:

Falling and landing directly on the shoulder.
Falling onto an outstretched hand, causing the impact to travel up the arm to the shoulder joint, forcing the ligaments to tear.
Shoulder collisions in contact sports.
Automobile accidents where blunt force is applied to the shoulder.

These are just some examples. Anytime the shoulder experiences direct trauma, there is a chance of AC joint separation.

It should be noted that not all acromioclavicular joint separations are equal. They are diagnosed using the Rockwood Scale, which identifies 6 different grades of shoulder separation. These grades are:

Grade 1: This is considered a mild separation, meaning the AC ligament is stretched or partially torn, but the collarbone remains in its normal location.
Grade 2: This is a moderate separation. The AC ligament is completely torn, and the coracoclavicular (CC) ligaments are sprained or slightly damaged. Additionally, the collarbone is slightly elevated, which can cause the appearance of a slight bump.
Grade 3: This is when a separation has become severe. The AC and CC ligaments are completely torn and the collarbone is extremely elevated, leading to a large, noticeable, painful bump.
Grade 4-6: These grades are extremely serious. Fortunately, injuries of this magnitude are extremely rare. These grades mean the collarbone has become so displaced that it is pushing through the trapezius muscle (grade 4), significantly elevated (grade 5), or displaced downward (grade 6).

This scale helps doctors to develop appropriate treatment plans. Generally speaking, the higher the grade of the separation, the more intense treatment will be.

For separations of grades 1-3, conservative treatments are usually effective. This includes immobilization using a sling or harness, pain management using NSAIDs, and icing the area. Additionally, after severe pain has subsided, physical therapy (PT) is a necessity. PT for ac joint separation focuses on restoring range of motion and strength to the shoulder joint. Usually, with this type of treatment, separations of grades 1-3 will heal in 2 to 12 weeks.

For separations of grades 4-6, surgery is often required. This usually involves the arthroscopic reconstruction of the ligaments. In the most severe cases, the trimming of the collarbone may be necessary to prevent it from rubbing against the shoulder blade. A sling is worn for about 6 weeks after surgery, and physical therapy is needed for up to 3 months before reaching full recovery.

At Boston Hand to Shoulder, one of our shoulder specialists will be able to determine the grade of your shoulder separation. They will then be able to develop a treatment plan that gives you the best chance of making a full recovery.