How to Manage a Shoulder Separation

References to shoulders generally touch upon strength: shouldering a burden requires it, as does carrying the weight of the world on your shoulders. However, those figurative tasks would be impossible to accomplish if your shoulder was in a weakened state, as it is when it’s separated.

A shoulder separation refers to an injury to the top of the shoulder where the front of the shoulder blade (acromion) attaches to the collarbone (clavicle), forming the acromioclavicular (AC) joint. A shoulder separation, also referred to as an AC joint injury, is an injury to one or more of the four ligaments that hold the two bones together so that the bones are no longer aligned properly.

AC separations can be caused by a traumatic injury, such a blow to the site, or by repetitive overuse of the shoulder. People under 35 are the most common victims of AC joint injuries, and men are five times more likely to sustain one than women. They are often the result of a sports injury, and people in the aforementioned age group are the most usual participants in contact sports or those where collisions are likely and can produce trauma, such as football, rugby, cycling and skiing.

Overuse of the joint through repeated stress from activities such as bench-pressing heavy weights or doing physical labour with the arms raised overhead may also lead to an AC joint injury.

Shoulder separations range from mild to severe and are graded from I to VI, depending on which ligaments are damaged and how severe the injury is. AC joint injuries graded from IV to VI generally result from high-force collisions that occur during motor vehicle crashes and must be treated surgically. Most athletes and others suffer simple AC joint injuries, Grades I, II or III.

A Grade I separation is the mildest and most common AC joint injury; the ligaments may be stretched or partially torn and the joint still lines up properly. In a Grade II dislocation, the acromioclavicular ligament is completely torn, but the ligaments at the rear of the shoulder blade, the coracoclavicular ligaments, remain attached. A Grade III separation is the most severe of the simple types and is a complete separation of the joint. All of the ligaments and the capsule surrounding the joint are torn; the shoulder sags and the clavicle is pushed up, forming a bump on the shoulder.

If you suffer an AC joint injury, you will have general shoulder pain and swelling, probably accompanied by bruising. The area above the AC joint will be especially tender and swollen and your shoulder won’t feel as strong as usual; its range of motion will also be compromised. In addition, you may have a visible bump on your shoulder and feel pain when lying on the side where the injury occurred. When you move your shoulder, you may feel a catching sensation or hear a popping sound.

Initially, for a shoulder separation, the goal is to reduce pain by immobilizing the shoulder in a sling and applying ice to the area for 20 to 30 minutes every two hours. Your doctor may also suggest taking an over-the-counter NSAID (non-steroidal anti-inflammatory). Rest is essential during the early stages of the separation. Once the acute stage of the injury has passed, you may begin rehabilitating your shoulder with the help of a physiotherapist who will help you return to your daily and desired activities. You can expect treatment to take at least six weeks.

Your physiotherapist will create a rehabilitation plan tailored to your particular injury and to your movement goals. The plan may include:

• Strength training to strengthen the muscles in the shoulder area. Injury to the area weakens the surrounding muscles, and they must be retrained to work together properly;
• Range of motion exercises to return the joint to proper functioning as swelling and pain recede. Reaching overhead or across the body are the motions that are most often affected by a shoulder separation;
• Functional training that trains the shoulder to work properly in order for the AC joint to effectively bear the often-heavy load assigned to it; and
• Manual therapy, hands-on manipulation that mobilizes and moves your AC joint and the surrounding muscles in order to improve flexibility, motion and strength in these hard-to-reach locations.

Once you’ve separated your shoulder, you’ll undoubtedly want to prevent it from happening again. Exercise and stretch your shoulder muscles regularly to keep them strong and ice your shoulder after physical activity. In addition, if you experience pain during a specific activity, stop immediately. As the saying goes, “An ounce of prevention is worth a pound of cure.”