A shoulder separation is the partial or complete separation of two parts of the shoulder: the collarbone (clavicle) and the end (acromion) of the shoulder blade (scapula). In a type II shoulder separation, the acromioclavicular (AC) ligament is completely torn, and the coracoclavicular (CC) ligament is either partially torn or not injured.
A shoulder separation (image) refers to the stretching or tearing of ligaments where the collarbone (clavicle) meets the shoulder blade (scapula), also called the acromioclavicular or AC joint. If these ligaments partially or completely tear, the clavicle can slip forward and detach from the scapula. A shoulder separation is usually caused by an impact to the front of the shoulder or by falling on an outstretched hand.
Shoulder Separation Symptoms and Signs
What are the symptoms of a shoulder separation?
Pain is the most common symptom of a separated shoulder, and is usually severe at the time of injury. Evidence of traumatic injury to the shoulder, such as swelling and bruising, are also commonly found.
The diagnosis of shoulder separation is often quite apparent from hearing a story that is typical of this injury, and a simple physical examination. An x-ray should be performed to ensure there is no fracture of these bones. If the diagnosis is unclear, an x-ray while holding a weight in your hand may be helpful. When this type of x-ray is performed, the force of the weight will accentuate any shoulder joint instability and better show the effects of the separated shoulder.
Are all separated shoulders the same?
No. Separated shoulders are graded according to the severity of the injury and the position of the displaced bones.
Shoulder separations are graded from type I to VI:
- Type I Shoulder Separation:
A type I shoulder separation is an injury to the capsule that surrounds the AC joint. The bones are not out of position and the primary symptom is pain.
- Type II Shoulder Separation:
A type II shoulder separation involves an injury to the AC joint capsule as well as one of the important ligaments that stabilizes the clavicle. This ligament, the coracoclavicular ligament, is partially torn. Patients with a type II separated shoulder may have a small bump over the injury.
- Type III Shoulder Separation:
A type III shoulder separation involves the same type of injury as a type II separated shoulder, but the injury is more significant. These patients usually have a large bump over the injured AC joint.
- Type IV Shoulder Separation:
A type IV shoulder separation is an unusual injury where the clavicle is pushed behind the AC joint.
- Type V Shoulder Separation:
A type V shoulder separation is an exaggerated type III injury. In this type of separated shoulder, the muscle above the AC joint is punctured by the end of the clavicle causing a significant bump over the injury.
- Type VI Shoulder Separation:
A type VI shoulder separation is also exceedingly rare. In this type of injury the clavicle is pushed downwards, and becomes lodged below the corocoid (part of the scapula)
Shoulder Separation Severity and Type
The severity of the separation is determined by the amount and direction of joint separation and ligament damage that shows up on x-rays. Type I and II AC joint injuries are considered mild and may respond to conservative treatment. In more severe type IV, V, and VI shoulder separation injuries, the supporting ligaments may actually be torn. These injuries are generally treated with surgery.
Shoulder Separation Treatment
Self-Care at Home
Like other problems with bones and joints, the first priority is to prevent further harm and ease the pain by immobilizing the joint and applying ice.
- Shoulder slings are perfect for immobilization.
- The application of ice helps decrease the swelling to the area. This, in turn, decreases pain and expedites recovery.
- An effective home ice pack can be made by filling a large storage-size zip-lock bag with crushed ice. Drop the closed bag into a pillowcase and apply directly to the top of the shoulder.
- The ice pack should be removed when the skin is completely numb or if you sense a burning or pins-and-needles feeling. After allowing the skin to rewarm for 10-15 minutes, the ice may be reapplied.
- Ice should be used for the first 12 hours of most shoulder separations.
- Acetaminophen (Tylenol) or ibuprofen (Motrin) or similar medications can be given for pain and swelling.
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