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A shoulder separation injury occurs when trauma damages the ligaments around the acromioclavicular (AC) joint. It’s where the collarbone (clavicle) meets the shoulder blade (scapula). If the injury is severe, part of the shoulder blade may separate from the collarbone. A shoulder separation is not the same as a dislocation. In a dislocation, your upper arm bone (the humerus) pulls out of the shoulder joint. Shoulder separations are common, especially in active young adults.
Your shoulder blade connects to your upper arm bone and to your collarbone with ligaments. The highest point of your shoulder blade is called the acromion. Two AC ligaments attach the acromion to your collarbone. This is the AC joint. Another ligament, the coracoclavicular (CC) ligament, connects part of your shoulder blade to your collarbone.
Injury may damage these ligaments around your joint. If the damage is severe, the collarbone and shoulder blade pull apart causing a shoulder separation. Your shoulder blade may move downward from the weight of your arm.
Healthcare providers rate injuries to the AC joint based on how severe they are. A type I injury is the most mild. A type VI injury is the most severe. In a type I injury, the AC ligaments are only partially torn, but the bones remain in place. In a type III injury, both the AC and CC completely tear. Your collarbone and shoulder blade are slightly out of line. With more severe injuries, the bones pull out of position even more. There may also be damage to other tissues around the area.
Different types of shoulder injuries can lead to shoulder separation. Often, the injury happens when you fall directly on the top of your shoulder, when your arm is close to your body. A direct blow to your shoulder, or falling onto an outstretched hand, can also cause the injury. Car accidents and sports injuries are potential causes.
Possible symptoms of shoulder separation include:
These symptoms vary quite a bit depending on how severe the injury is. A type I injury may cause only slight pain, mild swelling, and a normal-appearing shoulder and arm. A slightly more severe injury might cause greater pain and swelling, though the arm and shoulder may still appear mostly normal.
With a more severe injury, the top part of the shoulder may look deformed, and the pain and swelling may be more intense. The shoulder blade’s downward movement can cause a bulge above the shoulder, which also appears to droop. The collarbone may go far above the acromion of your shoulder blade. There may also be bruising of the area. In some cases, the collarbone may even poke out through the skin.
Your healthcare provider will take ask about your medical history and give you a physical exam. He or she will look at your shoulder and arm and press on your AC joint, which may hurt.
More severe shoulder separation injuries are easy to diagnose with just a physical exam. This is because the shoulder will clearly look deformed. In any case, you will likely need an X-ray of your joint. This can help give more information about how severe your injury is. During the exam or X-ray, your healthcare provider might have you hold a weight on the injured side. This can make a deformity more obvious.
Your treatment may depend on the severity of your injury, and may include:
Your healthcare provider may show you special exercises to help rebuild your strength, flexibility, and range of motion as you heal. You’ll likely need to start these as soon as your pain starts to go away.
You may not need any other treatments if you have a type I, type II, or type III injury. If your injury is more severe, you may need surgery. Some type III injuries may also need surgery as well, especially for athletes. Your healthcare provider may first want to see if your AC joint heals on its own before trying surgery.
Surgeons have a number of ways to bring your collarbone back into alignment with the scapula. They might fix the bones together using screws. Or the ligaments that support your AC joint may be repaired. A ligament from another part of your body may be used to repair it.
Your end result may also depend on the severity of your injury. Most people will get back all or almost all normal arm and shoulder function, but a slight deformity may remain. If you have a mild shoulder separation, you may totally recover within a few weeks. More severe injuries may need greater recovery time.
A small number of people continue to experience pain in their AC joint for weeks or months after their injury. This might be due to abnormal contact between the bones. Arthritis can also develop in the joint because of your injury. You might eventually need surgery to treat these symptoms.
Most cases of shoulder separation are not preventable. You may be able to reduce your risk of shoulder separation by taking basic safety precautions. Make sure to always wear a seatbelt while driving or riding in a car. Use the proper protective gear for your sport.
Your healthcare provider will give you instructions about when you can go back to your normal activities. Depending on the extent of your injury, this may take a few weeks, or it may be longer. Even after that, you may need to protect your joint from injury for a while, so that your ligaments can fully heal. Athletes may need longer recovery times.
Be sure to follow all your healthcare provider’s instructions. Make sure to do exercises as advised. This will help increase your chances for a full recovery.
See your healthcare provider right away if you have injured your shoulder and think you might have a shoulder separation. Call your provider if your symptoms do not get better after your injury. Get emergency care if you can’t move your arm at all, if you have numbness in your arm or hand, or if you have signs of poor circulation, such as a cool, pale hand.
In a shoulder separation, trauma damages the ligaments around your AC joint. This joint is where your collarbone and shoulder blade meet. If the injury is severe, the acromion of your shoulder blade separates from your collarbone.
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