Shoulder Separation

What is a shoulder separation?

A shoulder separation occurs when you tear the ligaments that hold your collarbone (clavicle) to the joint where it meets the shoulder blade. When the ligament tears, your collarbone may move out of its normal place and stick up under the skin just below your shoulder. Another term for shoulder separation is acromioclavicular (AC) separation or sprain.

How does it occur?

A shoulder separation can result from a blow or fall on your shoulder. It also can result from a fall on your outstretched hand or arm. It is a common injury in contact sports such as football, rugby, hockey, or lacrosse. It may happen during downhill skiing, volleyball, rock climbing, and soccer.

What are the symptoms?

Symptoms include the following:

• severe pain at the moment the injury occurs
• limited shoulder movement and tenderness on top of your shoulder at the end of your collarbone
• swelling and bruising of your shoulder
• a twisted shoulder

How is it diagnosed?

Your healthcare provider will examine your shoulder for tenderness and a bump over the tip of your collarbone. You will need to have X-rays to check for a fracture.

How is it treated?

The treatment of your separated shoulder depends on the severity. Most often, treatment will include:

• Wear a sling or shoulder immobilizer. The sling or immobilizer will keep you from lifting your arm away from your chest and help the ligaments heal. Your shoulder will be kept immobile until you are pain free. Then you will start rehabilitation exercises.
• Put an ice pack, gel pack, or package of frozen vegetables, wrapped in a cloth on the area every 3 to 4 hours, for up to 20 minutes at a time.
• Take an anti-inflammatory such as ibuprofen, or other medicine as directed by your provider. Nonsteroidal anti-inflammatory medicines (NSAIDs) may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take for more than 10 days.

In some cases surgery may be needed. Your arm will then be in a sling for up to 6 weeks to allow healing before you start rehabilitation exercises.

How long will the effects last?

Some separations heal by themselves in 2 to 4 weeks without any loss of shoulder use. However, you may have slight stiffness or loss of movement in the shoulder. This is usually temporary. A severe separation may take 2 months or more to heal, particularly if you have surgery to repair it.

Rarely the tip of the clavicle may develop degenerative changes over time and have continuing pain. Surgery can be done to remove the damaged part of the clavicle.

You may have a permanent bump over your shoulder joint after a separation. The bump does not normally cause other medical problems.

How can I take care of myself?

• Avoid participating in sports until the injury has healed.
• Move your shoulder to prevent a frozen or stiff shoulder.
• You may need to work with a trainer or physical therapist to strengthen your shoulder.

When can I return to my normal activities?

Everyone recovers from an injury at a different rate. Return to your activities depends on how soon your shoulder recovers, not by how many days or weeks it has been since your injury has occurred. The goal of rehabilitation is to return to your normal activities as soon as is safely possible. If you return too soon you may worsen your injury.

You may safely return to your activities when:

• Your injured shoulder has full range of motion without pain.
• Your injured shoulder is as strong as the uninjured shoulder.

What can I do to help prevent recurring shoulder separation?

Exercise and lift weights under the supervision of a trainer or physical therapist to strengthen your shoulder muscles. This also helps to strengthen your ligaments and tendons.