Shoulder Separation/AC Sprain

Shoulder Separation/AC Sprain

A shoulder separation happens when the ligaments that attach the collarbone to the top of the shoulder blade have been injured resulting in a tear in the tissue. The medical term for this injury is acromioclaviclar joint (AC joint) sprain. A shoulder separation is common in young athletes. In most shoulder separation cases, there will be a bump at the end of the collarbone near the shoulder, or the shoulder will hang lower than normal. This injury is different from a shoulder dislocation where the arm bone slips out of the main shoulder joint.

Understanding the Acromioclavicular (AC) joint

The acromioclavicular (AC) joint is where the collarbone (clavicle) meets the shoulder blade (scapula). The highest point of your shoulder blade is called the acromion. There are ligaments connecting the collarbone to the shoulder blade. When a shoulder separation occurs, these ligaments are damaged.

What happens in a shoulder separation (AC sprain)?

The severity of a shoulder separation is related to how many of the ligaments connecting the collarbone to the shoulder blade are damaged. Sometimes, only the ligaments around the AC joint are partially torn, which only produces pain. In more severe shoulder separations, the ligaments are torn and the collarbone and shoulder blade separate.

What causes shoulder separation?

Different types of injuries can lead to shoulder separation. Some of these include:

• Falling on the shoulder with your arm close to your body
• A direct impact to the shoulder
• Falling onto an outstretched hand
• Car accident
• Sports injury

How does a shoulder separation feel?

Symptoms can vary a lot depending on how severe the injury is and can include:

• Pain at the top of your shoulder
• Pain when touching your AC joint
• Swelling
• Bruising
• Change in the shape of your shoulder
• Bulge above the shoulder blade
• Shoulder that appears to hang lower than normal
• Collarbone that moves upward
• Limited movement in your shoulder, such as when you try to lift your arm

How is a shoulder separation diagnosed?

Severe shoulder separation injuries are easy to diagnose with just a physical exam. This is because the shoulder will clearly look abnormal. If there is a fracture, you will need an X-ray of your main shoulder joint. This will help give more information about the injury. An injury to the AC joint is rated based on how severe it is. The following types of injury generally apply to high school-age kids and older:

• Type I. This injury is the mildest. It may cause only slight pain and swelling.
• Type II. The AC ligaments are only partially torn. The bones remain in place.
• Type III. All joint ligaments completely torn. The collarbone and shoulder blade are out of line.
• Type V. The bottom of the collarbone has moved above the top of the shoulder blade. This injury can happen in younger children, but it is much less common.

How is a shoulder separation treated?

The treatment may depend on how serious the injury is. It can include:

• Resting your shoulder with a sling or other support.
• Using cold packs on the injured area.
• Using over-the-counter pain medicines.

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. Your specialist may first want to see if your main shoulder joint heals on its own before recommending surgery.

How soon can I play after a shoulder separation?

Most people will get back to normal arm and shoulder function, but a bump in your shoulder may remain. If you have a mild shoulder separation, you may completely recover within a few weeks. More severe injuries may need more time to heal.

Your specialist will give you instructions about when you can go back to your normal activities. This may take a few weeks, or it may be longer. You may need to protect your main shoulder joint from injury for a while. This is so that your ligaments can fully heal. Contact athletes may need longer recovery times.