Have you recently injured your shoulder? An AC joint separation, often referred to as a “separated shoulder,” is a common injury that can range from mild discomfort to severe pain, depending on the extent of the damage. Whether caused by a fall, sports injury, or other trauma, this type of shoulder injury can significantly impact daily activities and overall quality of life.
In this blog post, we will explore everything you need to know about AC joint separation, including its causes, symptoms, diagnosis, different grades, treatment options, and recovery. You will also learn about when to seek professional help from a qualified orthopedic physician.
What is AC Joint Separation (Shoulder Separation)?
The acromioclavicular (AC) joint is located at the top of the shoulder, where the clavicle (collarbone) meets the acromion at the top of the shoulder blade. An AC joint separation occurs when the ligaments that hold the AC joint together are damaged, causing the clavicle to become displaced from the acromion. This results in a visible “bump” on the shoulder and can range in severity from mild sprains to complete ligament tears.
Despite being called a “shoulder separation,” it’s important to note that this injury does not involve the shoulder joint itself but rather the AC joint. The severity of the injury depends on how many ligaments are damaged and how much displacement occurs between the clavicle and acromion.
Causes of AC Joint Separation
AC joint separation typically occurs due to trauma or injury that places excessive stress on the shoulder. Some of the most common causes include:
- Direct impact to the shoulder: This can happen during contact sports like football, hockey, or rugby, where players frequently collide with one another or the ground.
- Falling on an outstretched arm: A common cause in both athletes and non-athletes, this type of fall places significant force on the shoulder joint.
- Motor vehicle accidents: High-impact accidents can also result in a separated shoulder due to the force of impact on the upper body.
- Overuse injuries: Repetitive strain on the AC joint can weaken the ligaments over time, making them more susceptible to injury.
Symptoms of AC Joint Separation
The symptoms of an AC joint separation vary depending on the severity of the injury. Some people may experience only mild discomfort, while others may have intense pain and noticeable physical deformities. Common symptoms include:
- Pain at the top of the shoulder: This is the most immediate and prominent symptom, especially after an injury.
- Swelling and bruising: The area around the AC joint may become swollen or bruised due to ligament damage.
- Visible bump or deformity: In more severe cases, the clavicle may be displaced, creating a visible bump on the shoulder.
- Limited range of motion: The injured shoulder may feel stiff or weak, making it difficult to lift the arm or perform normal activities.
- Tenderness when touching the AC joint: Pressing on the area can cause sharp pain or discomfort.
Diagnosing AC Joint Separation
Diagnosing an AC joint separation involves a combination of physical examination and imaging tests. For most patients, the diagnostic process typically includes:
- Physical Examination: Your doctor will assess the injured shoulder by checking for tenderness, swelling, and deformities. He or she may also ask you to move your shoulder in different directions to evaluate your range of motion and pain levels.
- X-rays: X-rays are commonly used to confirm the diagnosis and determine the severity of the separation. By comparing the injured shoulder with the uninjured one, the doctor can evaluate the extent of the displacement.
- MRI or Ultrasound: In more complex cases, especially if soft tissue damage is suspected, an MRI or ultrasound may be recommended to provide a more detailed view of the ligaments and surrounding structures.
Types (Grades) of AC Joint Separation
AC joint separations are classified into different grades based on the severity of the injury and the amount of displacement between the clavicle and acromion. These grades help guide treatment options and recovery expectations:
- Grade One: A mild sprain where the ligaments are stretched but not torn. There is little to no separation between the clavicle and acromion, and the shoulder often appears normal. Pain is typically mild, and recovery is quick with conservative treatment.
- Grade Two: A moderate sprain where the AC ligament is partially torn. The clavicle may be slightly displaced, causing a minor bump at the top of the shoulder. There is increased pain and some limitation in shoulder movement.
- Grade Three: A severe injury where both the AC ligament and the coracoclavicular (CC) ligament are completely torn. The clavicle is visibly displaced, creating a more pronounced bump. The shoulder may feel unstable, and pain is significant.
- Grades Four Through Six: These grades represent more extreme cases where the clavicle is displaced to a greater degree. These are less common and often involve additional damage to surrounding muscles or tissues. Surgery is typically required for these types of injuries.
Treatment Options for AC Joint Separation
Treatment for AC joint separation depends on the severity of the injury, with most mild cases responding well to nonsurgical methods. Let’s explore the treatment options based on the injury’s grade:
Nonsurgical Treatments for Grades one and two
- Rest and Ice: Resting the injured shoulder and applying ice can help reduce inflammation and pain. This is usually the first step in treating a mild to moderate AC joint separation.
- Immobilization: A sling or shoulder brace may be used to support the shoulder and limit movement during the healing process. Immobilization is usually recommended for a few days to a couple of weeks, depending on the injury’s severity.
- Pain Management: Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage pain and reduce swelling.
- Physical Therapy: Once the initial pain and swelling subside, physical therapy is important to restore strength and range of motion. A therapist will guide you through exercises designed to strengthen the muscles around the shoulder joint and improve mobility.
Surgical Treatment for Grades Three to Six
In more severe cases, especially grades three and above, surgery is often necessary to repair the damaged ligaments and stabilize the clavicle. Surgical options include:
- Ligament Reconstruction: During this procedure, the surgeon uses a graft to reconstruct the torn ligaments, stabilizing the clavicle and restoring normal shoulder function.
- Clavicle Stabilization: In some cases, metal pins or screws may be used to hold the clavicle in place during the healing process. These devices are usually removed after the ligaments have healed.
Post-surgical recovery will involve physical therapy and a gradual return to normal activities. Full recovery may take several months, depending on the severity of the injury and the success of the surgery.
Recovery After AC Joint Separation
Recovery from an AC joint separation depends on the grade of the injury and the treatment method used. Here’s a general timeline for recovery:
- Grade One: Most people recover within two to four weeks with rest and physical therapy. Normal activities can usually be resumed without restrictions.
- Grade Two: Recovery may take four to six weeks. Physical therapy plays a crucial role in regaining strength and mobility.
- Grade Four: Recovery can take several months. If surgery is not required, patients may still experience some residual pain or weakness. If surgery is performed, the recovery timeline extends further due to the healing process and rehabilitation.
During recovery, it’s essential to avoid activities that put strain on the shoulder, such as heavy lifting or overhead movements, until your doctor or therapist clears you for those activities.
When to See an Orthopedic Doctor
While some mild AC joint separations can be managed with conservative treatment at home, there are situations where it’s important to seek medical advice from an orthopedic doctor:
- Severe Pain or Deformity: If you notice a visible bump on the shoulder or experience intense pain, it’s crucial to get an evaluation to determine the extent of the injury.
- Limited Shoulder Movement: If you are unable to move your shoulder without significant pain or discomfort, you should see a doctor to prevent further complications.
- Chronic Pain: If pain persists for several weeks despite rest and treatment, it’s a sign that the injury may require more advanced care.
- Weakness or Instability: If your shoulder feels unstable or weak or if you experience repeated shoulder dislocations, an orthopedic evaluation is needed.
An orthopedic doctor can provide a personalized shoulder care plan based on your specific injury, and they can also determine if shoulder surgery is necessary for more severe cases.
Find the AC Joint Separation Relief You Deserve
AC joint separation, or separated shoulder, is a common shoulder injury that ranges in severity from mild ligament sprains to complete tears. Understanding the causes, symptoms, and treatment options is essential for proper recovery. While many cases heal with conservative treatments like rest, ice, and physical therapy, more severe injuries may require surgery to restore shoulder function. If you’re experiencing ongoing pain or instability in your shoulder, don’t hesitate to consult an orthopedic doctor for a thorough evaluation and treatment plan tailored to your needs. Talk to one of our physicians who specializes in hand surgery to learn about your options.
The Orthopedic Clinic is dedicated to a patient-centered, individualized approach to orthopedics — not just treating conditions. We’ll work closely with you to take your lifestyle and health goals into account before recommending a treatment plan. If you are currently exploring nonsurgical or surgical options for AC joint separation, the highly skilled physicians and surgeons at The Orthopedic Clinic are here to help you find lasting relief and return to an active lifestyle. Contact us today to learn more.