Shoulder pain isn’t normal, and you shouldn’t ignore it. If pain in your shoulder is making everyday tasks difficult, you need to see an orthopedic specialist with knowledge and experience in shoulder pain diagnosis and treatment, like the experts at OCC – Advanced Orthopedic & Sports Medicine Specialists in Denver, Parker, or Aurora, Colorado. If left untreated, a shoulder separation can lead to many complications, including permanent pain, weakened muscles, and loss of range of motion. The renowned team at Advanced Orthopedic is here to help you regain full strength, mobility, and comfort. It’s important to have them evaluate you to determine the severity of your condition and decide which treatment is necessary.

OVERVIEW

A separated shoulder is an injury to the acromioclavicular (AC) joint, which is the area where the collarbone (clavicle) meets the highest point of the shoulder blade (acromion). This occurs when the ligaments between the clavicle and acromion tear or stretch too much. The tear loosens the joint connection between the collarbone and shoulder blade, causing them to separate or move apart from one another painfully. Other names for this condition are acromioclavicular joint separation or AC joint separation. Studies show that acromioclavicular joint injuries may be the cause of as many as 40% of all shoulder injuries. Shoulder separations are common, especially in active young adults. They account for 9% of all injuries involving collision sports like football, lacrosse, and hockey.

ABOUT THE SHOULDER JOINT

The shoulder joints are located at the top of the arm. They connect the arms to the torso. A joint is where the ends of two bones make contact to allow motion. The shoulder is made up of two joints that connect the three bones of the shoulder. The three bones in the shoulder are the shoulder blade (scapula), collarbone (clavicle), and upper arm (humerus). The two joints that make up the shoulder joint are the acromioclavicular joint which joins the top of the shoulder blade (acromion) and the collarbone together. Below it, the glenohumeral joint joins the rounded top of the upper arm bone into the shoulder blade (glenoid cavity of the scapula). The bones of the shoulder are supported by ligaments and tendons, muscles, and cartilage (a flexible material that covers the bones where they meet at the joint allowing the bones to move against each other), bursa (fluid-filled sacs within the joint that provide cushioning) and synovial membrane (a sticky fluid that surrounds the joint to lubricate it and facilitate movement).

WHAT IS SHOULDER SEPARATION?

Simply put, a shoulder separation (known as an acromioclavicular (AC) joint sprain), occurs when the ligaments that connect the collarbone to the shoulder blade are torn: Shoulder separations can be mild to severe. Healthcare providers classify acromioclavicular joint separations based on the extent of the injury and how many ligaments are involved. Providers frequently use a rating system called the Rockwood classification of AC joint injuries, which includes:

• Type I: this injury involves a sprain or partial tear of the acromioclavicular (AC) ligaments with no injury to additional ligaments that stabilize the clavicle, called coracoclavicular (CC) ligaments
• Type II: this injury involves a complete tear of the AC ligaments and a sprain or partial tear of the CC ligaments
• Type III: this injury involves a complete tear of the AC and CC ligaments
• Type IV: this injury involves torn ligaments, and the clavicle is pushed back behind the acromioclavicular joint.
• Type V: this injury involves torn ligaments, and the end of the clavicle punctures the muscle above the acromioclavicular joint
• Type VI: this injury involves torn ligaments, and the clavicle pushes downward and becomes lodged underneath your coracoid (part of the shoulder blade)

CAUSES

The main cause of shoulder separation, also known as an acromioclavicular (AC) joint injury, is a traumatic impact to the shoulder, such as falling directly onto the outside of the shoulder with enough force to tear the ligaments.

While there’s no sure way to prevent a separated shoulder, other causes may include:

• Repetitive motions with the shoulder
• Overuse or straining of the shoulders, particularly in people aged 65 and older
• Manual labor
• Accidents and falls.
• Car accidents

Sports that pose a higher risk of injury are:

• Football
• Hockey
• Rock climbing
• Rugby
• Soccer
• Skiing
• Volleyball
• Jet Skiing
• Gymnasts

SYMPTOMS

Separated shoulder symptoms vary depending on the extent of the injury. A type I injury may cause only slight pain, mild swelling, and a normal-appearing shoulder and arm. A slightly more severe injury might cause greater pain, tenderness, and swelling, though the arm and shoulder may still appear mostly normal. With a more severe injury, the top part of the shoulder may look deformed, and the pain and swelling may be more intense. The shoulder blade’s downward movement can cause a bulge above the shoulder, which also appears to droop. The collarbone may go far above the acromion of the shoulder blade. There may also be bruising of the area. In some cases, the collarbone may even poke out through the skin. In all cases limited motion in the shoulder area occurs, and one might have numb or cold fingers.

NON-SURGICAL TREATMENTS

Most shoulder separation injuries require nonsurgical treatment. A separated shoulder recovery time may take a few days to less than six weeks for a mild injury. In these cases, treatment may include the following:

• Rest and activity modification, avoiding activities that stress the shoulder such as lifting heavy objects or overhead motions
• Ice packs and medications such as NSAIDs (nonsteroidal anti-inflammatory drugs), like ibuprofen and naproxen, aspirin or acetaminophen to reduce pain
• Use of a sling to keep the shoulder in place while healing
• Taping or bracing
• Corticosteroid  injections
• Physical therapy—after the initial healing period, PT is essential to restore strength, flexibility, and range of motion
• Gradual return to activity

WHEN IS SURGERY INDICATED?

Surgery may be necessary in more serious cases (such as type IV, V, or VI injuries on the Rockwood scale) or after determining that nonsurgical treatments aren’t the best option. It may be an option when fingers are numb or cold, arm muscles are weak or the deformity of the shoulder is severe. Since the pain is due to the ends of the bones making contact with each other, the treatment is the removal of a portion of the end of the collarbone. The AC joint is one of the few joints in the body where one can live without a portion of the bone making up the joint. Regardless of the technique, the recovery and results are about the same.

GETTING THE RIGHT DIAGNOSIS.  GETTING THE RIGHT DOCTOR.

Finding an orthopedic surgeon that best meets your needs, whether non-surgical or surgical treatments, is critical. The highly trained specialists at OCC – Advanced Orthopedic & Sports Medicine Specialists in Denver, Parker, or Aurora, Colorado, confidently diagnose and treat the widest range of shoulder separation cases with the deepest expertise. Depending on the extent of your injury, your provider may order imaging tests, including X-rays, Ultrasound, or an MRI. They will check for a deformity or bump, the range of motion of your shoulder and other joints, damage to your nerves or blood vessels, and muscle strength. They will carefully determine the scale of your injury based on the Rockwood scale of severity. This rating helps determine the appropriate medical response, including the need for surgery, how long treatment could last, and what long-term effects might occur. The caring and attentive surgeons at Advanced Orthopedic discuss everything in detail in terms you can understand and answer all your questions. With professionalism and compassion, they can be your trusted partner in the journey to a healthier, pain-free, and more active life.