Shoulder Separation (AC Joint Dislocation)
Acromioclavicular (AC) joint separations are a common injury seen in the sports medicine clinic. They occur in athletes who suffer from sporting injuries and falls or accidents.
An AC joint, also called a shoulder separation, occurs when the collarbone (clavicle) separates from the shoulder blade (acromion). Ligament damage can range from a mild strain to a partial tear to a complete tear. AC joint separations are graded from Grade I to Grade VI depending on the ligaments injured. Higher-grade injuries also involve damage to the coracoclavicular ligament (CC ligament), resulting in deformity where the clavicle is displaced upwards.
A shoulder separation typically occurs from trauma, a fall on the shoulder, landing from a fall on an outstretched hand that transmits the force to the shoulder, and from a blow to the side of the shoulder.
The symptoms of an AC joint separation can vary depending on the severity of the injury but typically include:
- Severe pain at the top of the shoulder following an injury.
- Swelling and sometimes bruising can occur around the top of the shoulder joint.
- A noticeable bump or deformity at the top of the shoulder.
- Difficulty moving the arm.
Your UCSF Women’s Sports Medicine specialist will review your medical history, inquire about the injury and your symptoms, and examine the shoulder to assess pain, swelling, deformity, and range of motion.
X-rays are important to evaluate the position of the bones and may reveal higher-grade injuries when the clavicle is displaced upwards. A mild injury may look normal on an X-ray. X-rays are also important to rule out a fracture of the shoulder.
Treatment options are based on the severity of the injury.
Non-surgical treatments
Most AC joint injuries (Grade I to III) can be managed conservatively. This includes:
- Rest and immobilization: Avoiding activities that exacerbate pain and using a sling for comfort for a short period of time.
- Icing: Applying ice to reduce swelling and pain.
- Medication: Non-steroidal anti-inflammatory drugs (NSAIDs) to manage pain and inflammation.
- Physical therapy: Exercises to restore range of motion and strengthen shoulder muscles.
With conservative management, most patients, including athletes, can find relief and restoration of normal function. While Grade III injuries have a persistent bump or deformity where the ligaments were stretched at the AC joint, the shoulder can often return to normal function.
When is surgery indicated?
Surgery may be recommended for high-grade AC separations (Grade IV to VI). Surgery repairs tears in both the AC and CC ligaments and restores proper shoulder anatomy. The specific procedure depends on the extent of the injury and the patient’s activity level.
The timeline for returning to sports after a shoulder separation varies depending on the injury’s severity and the treatment method. For mild separations treated conservatively, athletes may return to sports within a few weeks once the pain is managed and strength and mobility are restored. However, for severe injuries requiring surgery, return to sports can take 5-6 months and involves a more structured rehabilitation process to ensure full recovery.
- Rehabilitation: A structured rehabilitation program is crucial, focusing on gradually increasing shoulder strength and mobility. Athletes are advised to follow their healthcare provider’s and physical therapist’s guidance closely during recovery.
- Gradual Return: Athletes should gradually return to their sport, starting with drills and gradually increasing intensity and eventually returning to high-impact and/or contact sports as their strength, balance, and proprioception return to normal.
The UCSF Women’s Sports Medicine Center supports female athletes of all ages and abilities, from the recreational to the elite athlete, with a team of sports medicine and orthopedic specialists. Our goals are to help you return to your activities and sports and prevent re-injury. Contact us to schedule a consultation to learn more.
References
- https://orthoinfo.aaos.org/en/diseases–conditions/shoulder-separation/
- Farrell TP, Zoga A. Acromioclavicular Joint. Magnetic Resonance Imaging Clinics of North America 28:2,.269-183.
- LeVasseur MR, Mancini MR, Berthold DP, Cusano A, McCann GP, Cote MP, Gomlinski G, Mazzocca AD. Acromioclavicular Joint Injuries: Effective Rehabilitation. Open Access J Sports Med. 2021 May 28;12:73-85. doi: 10.2147/OAJSM.S244283. PMID: 34093044; PMCID: PMC8169819.
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