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 May 11, 2005
Shoulder Separation
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"Separation" of the acromioclavicular (AC) joint, where the end of the collarbone meets the shoulder blade, is actually a sprain of the ligaments that connect the two bones. "Separation" is an old medical term that has been applied to the widening of the space between the bones. Since this problem involves ligaments, it really should be called a sprain.


AC separation is typically an injury of young, active people who fall on the shoulder. Most commonly, it occurs when a person lands on the point of the shoulder, driving the shoulder blade down relative to the clavicle. Patients often tell of being thrown over the handlebars when bicycling, being tackled while playing football, or being upended while skiing. As with sprains, there are degrees of severity.


Weight lifters, in particular those who do bench presses, often get AC separation. It can also occur in other situations where lifting occurs, or with injury such as falling on the shoulder.


A mild, or first-degree, sprain causes a minimal stretching of the ligaments without much tearing of fibers, and the joint remains stable. There will be pain and swelling around the joint. In a moderate, or second-degree sprain, the ligaments are stretched more and partially torn, and the outer end of the collarbone will partially snap in and out of the joint. This type of sprain is diagnosed by an x-ray


It is easiest to diagnose a severe, or third-degree, sprain. The complete disruption of all of the ligaments around the joint causes the collarbone to stand straight up.


The treatment for first- and second-degree shoulder sprains is rest. The patient will have to put the shoulder in a sling for one to three weeks, depending on the severity of the injury. Also, in addition to resting the shoulder, the patient must ice it for 20 to 30 minutes a few times a day in the beginning to ease the pain. These are particularly frustrating injuries because they can take six to eight weeks to heal. One may not be able to raise the arm laterally beyond 90 degrees until the injury has healed. For a third-degree shoulder sprain, surgical repair of the ligaments is necessary to fix the joint. Up to six weeks of recovery from surgery is necessary before a restrengthening program can be started. This program consists of range-of-motion and strengthening exercises similar to those used to rehabilitate a shoulder impingement. Braces and long-term slings are not recommended.


What caused the separation or sprain? What treatment do you recommend? Is surgical repair necessary? Does the shoulder need rest? for how long? When can rehabilitation and strengthening exercises start? How long does rehabilitation take? Is there any permanent damage? What can be done to prevent further problems in the shoulder?

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