Shoulder Separation 

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A shoulder separation (acromioclavicular joint injury) is the partial or complete separation of two parts of the shoulder: the collarbone (clavicle) and the end of the shoulder blade (acromion).

The collarbone and shoulder blade (scapula) are connected by the acromioclavicular (AC) joint, which is held together by two ligaments. They are called the acromioclavicular (AC) ligament and the coracoclavicular (CC) ligament. In a shoulder separation, these ligaments are partially or completely torn, and the injury is classified according to how severely they are injured. They are typically divided into the following types:

• Type I: The AC ligament is partially torn, but the CC ligament is not injured.
• Type II: The AC ligament is completely torn, and the CC ligament is either not injured or partially torn. The collarbone is partially separated from the acromion.
• Type III: Both the AC and CC ligaments are completely torn. The collarbone and acromion are completely separated.
• Type IV to VI: These types of shoulder separations are uncommon. They may involve tearing of the muscle that covers the upper arm and shoulder joint (deltoid muscle) and the one that extends from the back of the head, neck and upper back across the back of the shoulder (trapezius muscle).

A direct blow to the top of the shoulder or onto the shoulder, such as a fall from a bicycle, can cause a shoulder separation.

Signs and symptoms of a shoulder separation include:

• Pain at the moment the injury occurs
• Limited movement in the shoulder area due to pain, not weakness
• Swelling and bruising
• Tenderness over the AC joint on top of the shoulder
• The outer end of the collarbone may look out of place, or there may be a bump on top of the shoulder. 

Your doctor will take a medical history, conduct a physical exam and sometimes do an X-ray. They will check:

• For a deformity or bump
• The range of motion of your shoulder and other joints
• Blood flow, by taking your pulse and assessing your skin color and temperature
• For damage to your nerves or blood vessels
• The muscle strength of your shoulder and arm
• For broken shoulder bones or damage to the tendons in the shoulder (rotator cuff tear)

Your doctor will probably X-ray your injured shoulder and possibly your uninjured shoulder to help diagnose the severity of the separation.

Treatment of a shoulder separation depends on its severity. For a type I or II injury, you support your shoulder with a sling. You typically need the sling until the discomfort decreases, which can range from a few days to a week. Early physical therapy to strengthen your shoulder and regain range of motion is important for recovery and to prevent frozen shoulder, a condition that limits shoulder motion (adhesive capsulitis). You can return to normal exercises and activities as your pain and other symptoms go away.

Experts do not agree on the best treatment for type III injuries. Some doctors treat them with a sling and physical therapy, while others feel surgery may be needed.

Type IV to VI injuries should be evaluated for possible surgery.

To help relieve pain, put ice on the affected area and take nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen. Be safe with medicines. Read and follow all instructions on the label.