Shoulder Separation

Topic Overview

What is a shoulder separation?

A shoulder separation is the partial or complete separation of two parts of the shoulder: the collarbone (clavicle) and the end of the shoulder blade (acromion). See an illustration of shoulder separation injuries.

The collarbone and the shoulder blade (scapula) are connected by the acromioclavicular (AC) joint, which is held together primarily by the acromioclavicular (AC) and the coracoclavicular (CC) ligaments. In a shoulder separation (also called an acromioclavicular joint injury), these ligaments are partially or completely torn. A shoulder separation is classified according to how severely these ligaments are injured:

• In a type I injury, the AC ligament is partially torn, but the CC ligament is not injured. See an illustration of a type I injury.
• In a type II injury, 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. See an illustration of a type II injury.
• In a type III injury, both the AC and CC ligaments are completely torn. The collarbone and the acromion are completely separated. See an illustration of a type III injury.

There are three further classifications, types IV through VI, which are uncommon. These types of shoulder separations 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 across the back of the shoulder (trapezius muscle).

What causes a shoulder separation?

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

What are the symptoms?

Signs and symptoms of a shoulder separation include:

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

How is a shoulder separation diagnosed?

A shoulder separation is diagnosed through a medical history, a physical examination, and an X-ray. Any pain, especially when moving your arm away from your body, may indicate a shoulder separation.

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

How is it treated?

Treatment of a shoulder separation depends on its severity. For a type I or II injury, you support your shoulder with a sling. You generally need the sling until the discomfort decreases (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.

Treatment for type III injuries is controversial. Some health professionals treat them with a sling and physical therapy, while others feel surgery may be necessary.

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

To help relieve pain, put ice on the affected area and take nonsteroidal anti-inflammatory drugs, including aspirin (such as Bayer), ibuprofen (such as Advil), or naproxen sodium (such as Aleve). Do not give aspirin to anyone younger than 20 because of the risk of Reye's syndrome. Acetaminophen (such as Tylenol) can also help relieve pain.

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Author:	Jan Nissl, RN, BS	Last Updated: September 24, 2007
Medical Review:	William M. Green, MD - Emergency Medicine H. Michael O'Connor, MD - Emergency Medicine
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