Shoulder Separation: Causes & Treatment

What is shoulder separation?

A shoulder separation, also known as acromioclavicular joint injury, refers to partial or complete separation of two parts of the shoulder, namely the collarbone (clavicle) and the end of shoulder blade (acromion) an injury. It results from an injury to the ligaments that hold the collarbone to the shoulder blade.

Depending upon the severity of ligament injury, shoulder separation is classified into the following:

1. Type I injury - The acromion (AC) ligament is partially torn but clavicle (CC) ligament is not injured.
2. Type II injury - The AC ligament is completely torn while the CC ligament is uninjured or partially torn. The collarbone and acromion are partially separated from each other.
3. Type III injury - Both AC and CC ligaments are completely torn.
4. Type IV - IV injuries - These are uncommon, and involve tearing of the deltoid muscle (covering the upper arm and shoulder joint) and the trapezius muscle (extending from the back of head, neck and upper back, across the back of shoulder).

What are the causes of the disorder?

The most common cause of a separated shoulder is a sudden blow or impact to the shoulder, which stretches or tears the ligaments holding the collarbone to the shoulder blade.

What one needs to know about symptoms or signs?

Signs of shoulder separation include:

1. Pain from the moment of injury occurrence
2. Restricted movement of the shoulder due to the pain
3. Swelling and bruising
4. Tenderness at the top of the shoulder, over the acromion joint.
5. Deformity - the outer end of collarbone may appear out of place, or a bump on the top of the shoulder is noticeable.

Which specialist should be consulted in case of signs and symptoms?

A case of shoulder separation must be reported to an orthopaedic specialist, a doctor who specializes in treating bones and joints.

What are the screening tests and investigations done to confirm or rule out the disorder?

A separated shoulder is diagnosed through the following:

Physical exam A doctor will check for:

• Bump or deformity
• Range of motion in the shoulder and other joints; muscle strength in the shoulder and arm
• Blood flow, by checking the pulse, assessing skin colour and temperature
• Any broken shoulder bone or damage to tendons in the shoulder (rotator cuff tear)

X-ray An x-ray of the injured shoulder and comparison with that of the uninjured shoulder helps diagnose the severity of the separation.

What treatment modalities are available for management of the disorder?

Treatment options for separated shoulder include:

1. Medications - Shoulder pain can be alleviated through over-the-counter pain relievers.
2. Therapy - Options include
3. Physical therapy - Strength and motion can be restored in the shoulder through stretching and strengthening exercises. It is important to improve the range of motion following the injury to prevent frozen shoulder.
4. Ice treatment - Ice packs applied for 15-20 minutes helps reduce pain and swelling.
5. Rest - Type I or II injuries can be treated by immobilising the arm in a sling to relieve the pressure off the shoulder and promote healing. Activities that aggravate shoulder pain must be avoided.
6. Surgery - In severe cases (Type IV-VI injuries) or if pain persists after above treatments, surgery may be recommended to reconnect torn ligaments and stabilise or reposition injured bones. Surgery becomes necessary in the following cases:
   • Numbness in fingers; cold fingers
   • Muscle weakness in arm
   • Severe deformity of the joint

What are the known complications in management of the disorder?

The patient must be taken into emergency if the following are noted:

1. Numb or cold fingers
2. Severe pain; weakness in arm or fingers
3. Lump on top of shoulder

What precautions or steps are necessary to stay healthy and happy during the treatment?

Most patients recover within two to twelve weeks with pain medication and therapy. However, recovery may be prolonged if the patient also suffers from arthritis of the shoulder joint, damaged cartilage between the collarbone and shoulder blade or a severe shoulder separation.

Applying an ice pack every 10-15 minutes and taking pain relieving medication can alleviate the symptoms.

Sources:

"Shoulder Separation," AAOS, https://orthoinfo.aaos.org/topic.cfm?topic=a00033"Shoulder separation - aftercare," Medline Plus, NLM, NIH, https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000562.htm"Shoulder Separation," WebMD.com, https://www.webmd.com/a-to-z-guides/shoulder-separation-topic-overview"Shoulder Separation," MayoClinic.com, MayoClinic Staff, https://www.mayoclinic.org/diseases-conditions/separated-shoulder/basics/definition/con-20029283