A separated shoulder is not actually an injury to the shoulder joint. Instead, the injury involves the acromioclavicular joint (AC joint). Stretched or torn ligaments joining the collarbone to your shoulder blade causes a separated shoulder.
Anatomy
The shoulder is made up of three bones: the upper arm bone (humerus), the shoulder blade (scapula) and the collarbone (clavicle). The shoulder is a ball-and-socket joint, which means the ball of the upper arm fits into a shallow socket in your shoulder blade. The AC joint is where the collarbone meets the top of the shoulder blade (acromion).
What is a separated shoulder injury?
Most commonly, shoulder separations are caused from a fall directly onto the shoulder. The fall injures the ligaments that surround and stabilize the AC joint.
If the force is severe, the ligaments attaching to the underside of the clavicle are torn. This is what causes the separation of the collarbone and acromion. The acromion actually moves downward from the weight of the arm and creates a bump or bulge about the shoulder.
Some degrees of separation include:
- A mild separation involves a sprain of the AC ligament that does not move the collarbone and looks normal on X-rays.
- A more serious injury tears the AC ligament and sprains or slightly tears the coracoclavicular (CC) ligament, putting the collarbone out of alignment.
- The most severe separation completely tears both the AC and CC ligaments and puts the AC joint noticeably out of position.
Separated shoulder symptoms
Some signs and symptoms of a shoulder separation include:
- Bump or bulge above the shoulder
- Injury can range from a little change in configuration with mild pain to noticeably deformed and very painful
- Physician examination
Separated shoulder diagnosis
To determine whether you have a shoulder separation, your physician will ask you for a complete medical history, have you describe your symptoms and conduct a physical examination. Usually, a shoulder separation is easy to identify because of the deformity it shows. An X-ray may be necessary to rule out other problems.
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Separated shoulder treatment
Nonsurgical options include:
- Shoulder sling
- Cold packs
- Medication
How long does a separated shoulder take to heal?
If your pain and deformity is severe or persists longer than 12 weeks, your physician may suggest surgery.
For more severe injuries of the AC joint where the coracoclavicular ligaments are torn surgery can be done to reconstruct these. Both open and arthroscopic procedures are available.
A variety of different fixation devices are now commonly used that involve high strength sutures tied over metal buttons. In more chronic injuries soft tissue grafts are also in the reconstruction. This reduces the clavicle back down so it is in line with the acromion.
Separated shoulder recovery
After surgery patients are placed in a sling for six weeks. Overhead motion is avoided during this time to avoid loss of fixation. After six to eight weeks the sling is removed.
You will begin physical therapy to learn separated shoulder exercises. These movements will help you obtain range of motion and strength again.
Patients need to avoid heavy physical activity (lifting, overhead work, sports) for six months. Early motion and lifting with the surgical arm can lead to loss of fixation and recurrence of deformity.
Learn more about shoulder treatment at OrthoIndy.
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