Shoulder Separation: Overview

Shoulder Separation: Overview

A shoulder separation is an injury to a small joint located on the top of the shoulder. This joint is where a portion of the shoulder blade, known as the acromion, and the collarbone, known as the clavicle, come together. The joint itself is named for these two bones, the acromioclavicular joint, or A C joint for short.

In a shoulder separation, the supporting ligaments to this joint may be sprained or torn, and these two bones may separate from one another as a result. A shoulder separation is most common in young athletic males in their 20s to 30s and results from an acute injury to this area. The injury can result from a direct blow to the top of the shoulder, such as with contact sports like rugby or football. It can also happen with bicycle accidents or during snowboarding or skiing. Overall, shoulder separations account for 40% of all shoulder injuries.

Sometimes it is not a direct blow that causes this injury, but rather a fall on an outstretched arm, although this is not as common. When participating in contact sports, ensuring protective gear fits appropriately, and learning proper fall techniques can help contribute to the prevention of ac joint injury.

Now, let us take a closer look at the anatomy of the shoulder. When most people think of the shoulder joint, they think of the ball and socket joint, referred to as the glenohumeral joint. In a shoulder separation, we are actually talking about a different part of the shoulder nearby, the acromioclavicular joint. The AC joint is where the collarbone, the clavicle, and the acromion, the top bony part of the shoulder blade, meet. Here, the acromioclavicular ligament connects these two bones to one another.

During a mild injury, this ligament is sprained. However, in more severe injuries, this ligament is torn, and other supporting ligaments around the shoulder may be affected. These supporting ligaments, the coracoclavicular ligaments or C C ligaments for short, attach the collarbone to a bony projection on the front of the shoulder blade called the coracoid process. Injury to these ligaments in a shoulder separation allows the end of the collarbone to drift upwards even further away from the acromion.

After sustaining a shoulder separation injury, patients will experience shoulder pain, particularly right over the joint itself, and may even have bruising or swelling in that area. Some may notice a bump on the top of the shoulder. This is the end of the clavicle that pops up after damage to the ligaments. These are all things a healthcare professional will look for when evaluating a patient who has sustained an injury to the AC joint. In addition, they will examine the motion of the shoulder, which may be limited due to pain.

To help make the diagnosis of shoulder separation, as well as to rule out other bony injuries that may occur with AC joint injury like fracture, x-rays are obtained. X-rays are also used to classify the severity of injury based on the distance of separation between the clavicle and acromion. In mild injuries, the bones may not have separated at all, meaning the AC ligament connecting the 2 bones is sprained but not torn. In other cases, clear separation of the clavicle and acromion has occurred, meaning the CC ligaments have torn in addition to the AC ligament. If there is any uncertainty in the diagnosis, an MRI may also be ordered.

After the evaluation, the surgeon will review findings with the patient and discuss next best steps for treatment, whether that is nonAfter surgeryoperative management or surgical intervention.