AC Joint Separation

Damage to the shoulder ligaments can range from sprains to complete tears and can result in shoulder deformity and loss of mobility. Ligament damage is graded from mild to severe. The most common type of AC joint separation is a complete dislocation of the joint and severe damage to the shoulder ligaments.

Symptoms include:

• Pain at the top of the shoulder
• Swelling and bruising
• Visible deformity such as a bump at the top of the shoulder
• Difficulty moving the arm
• Weakness in the arm
• A popping or clicking sound in the shoulder

The most common cause of shoulder separations is a fall onto the shoulder, which forces the shoulder out of its socket and damages the shoulder ligaments. Other causes can include direct trauma to the shoulder, such as from a car accident, or repetitive stress on the joint, such as from sports that involve overhead arm motions. In some cases, the ligaments that hold the joint in place may stretch or tear with age, which can also lead to a separation.

In addition to trauma, the shoulder joint can also be separated by repetitive overhead motions. This is seen most commonly in athletes who participate in throwing sports, such as baseball and tennis. The repetitive stress on the ligaments holding the clavicle and shoulder together can eventually lead to a separation.

Your Orthopedic Specialist will review your medical history, inquire about how you injured your shoulder and your symptoms. They will perform a physical exam checking range of motion, swelling and bruising X-rays. A deformity of the shoulder is a cardinal symptom. X-rays will be ordered to evaluate the bones in the joint. With this information, your clinician will make a diagnosis and recommend treatment options.

Treatment for a shoulder separation will depend on the severity of the injury, and the patient’s needs and activity level. The goal of treatment is restoration of a fully functioning, pain-free and stable shoulder.

Grade I and II separations can be successfully treated with conservative methods, such as ice, rest, and pain medication, and a sling may also be recommended. Most people, even professional athletes, with grades I & II injuries find relief of symptoms and return of function with conservative measures. Physical therapy may also be recommended to help strengthen the muscles around the shoulder and stabilize the joint. However, if the pain continues after conservative treatment there may be other conditions that require treatment.

Some grade 3 separations may be treated with conservative measures, depending on the patient’s needs and activity level.

Severe shoulder separations with complete tears of the ligaments are unstable. Grades 4-6 will usually require surgery to repair or reconstruct the ligaments to stabilize the joint. In the most severe cases, the clavicle may also be fractured and require repair. Following surgery, physical therapy will be necessary to help regain strength and range of motion. Studies report good clinical outcomes from reconstruction surgery.

If not treated properly, a shoulder separation can lead to long-term problems, such as chronic pain, arthritis, and decreased range of motion.