Shoulder Separation

A shoulder separation is when the ligaments are injured that attach the collarbone to the roof of the shoulder. It is different from a shoulder dislocation when the ball pops out of the socket.  A shoulder separation is common, especially in active people. The shoulder will have a bump at the end of the collarbone. A fracture of the distal clavicle can look very similar to a shoulder separation.  

Understanding the shoulder joint

Part of  the shoulder joint is called the acromioclavicular (AC) joint. It’s where the collarbone (clavicle) meets the shoulder blade (scapula). Your shoulder blade connects to your upper arm bone and to your collarbone with ligaments. Ligaments are strong, stretchy tissue. 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. The coracoclavicular (CC) ligament connects part of your shoulder blade to your collarbone.

What causes shoulder separation?

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

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

Symptoms of shoulder separation

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 shape of your shoulder
  • Bulge above the shoulder
  • Shoulder that appears to droop
  • Collarbone that moves upward
  • Limited range of motion in your shoulder, such as when you try to lift your arm

Diagnosing shoulder separation

Your health care provider will ask about your health 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.

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, where a fracture is suspected you will likely need an X-ray of your 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 types are:

  • 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. Both the AC and CC completely tear. The collarbone and shoulder blade are slightly out of line.
  • Type VI. The bottom of the collarbone is displaced above the top of the acromion.

Treatment for shoulder separation

Your treatment may depend on how serious the injury is. Treatment may include:

  • Resting the joint with a sling or other support
  • Using cold packs on the area
  • Pain medicines

Your health care provider may show you special exercises to do. These will 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. Your health care provider may first want to see if your AC joint heals on its own before trying surgery.

Recovering from shoulder separation

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

Your health care provider 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 joint from injury for a while. This is so that your ligaments can fully heal. Athletes may need longer recovery times.

Be sure to follow all your health care provider’s instructions. Make sure to do exercises as advised. This will make it more likely for you to recover fully.

Possible complications of shoulder separation

A small number of people have pain in their AC joint for weeks or months after their injury. This may be because of abnormal contact between the bones. Arthritis can also develop in the joint because of your injury. You may need surgery to treat these symptoms.

Preventing shoulder separation

You may be able to lower your risk for shoulder separation by taking basic safety precautions. Make sure to always wear a seatbelt while driving or riding in a car. Use the protective gear for your sport.

When to call your health care provider

Call your health care provider right away if you have any of these:

  • Fever of 100.4°F (38°C) or higher
  • Pain that gets worse
  • Symptoms that don’t get better, or get worse
  • You cannot move your arm at all
  • Numbness in your arm or hand
  • Signs of poor blood flow, such as a cool, pale hand

The Sport Medicine clinic offers comprehensive care and treatment for children and adolescents with acute and chronic injuries. Call 832-22-SPORT (227-7678) for an appointment.