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Many people believe them to be the same injury, but the two are completely different.
Shoulder separations refer to a disruption of the ligaments which hold the collarbone to the shoulder
blade. When these ligaments are ruptured, the collarbone rises out of place from the shoulder and
“separates.” Medically, this is referred to as an Acromio-Clavicular separation. As the clavicle
(collarbone) attaches to the acromion (side extension of the shoulder blade), it is held by three
ligaments. These ligaments stabilize the clavicle and hold it down toward the top of the chest. Injury to
these ligaments “springs” the collarbone upward from its normal position.
Run your hand along your collarbone; as the shoulder is approached, you will feel a small bump—this is
the acromio- clavicular (A-C joint). A-C separations usually occur from a direct force as one falls
violently onto the point of the shoulder. The shoulder is forced downward as the ligaments holding the
collarbone tear. The injury is common in contact sports, such as football, rugby, hockey, and lacrosse.
Football players who carry the ball, such as backs and ends, are more susceptible because their
shoulders are directly hit when they are tackled. However, the improvement and effectiveness of
shoulder pads over the years has diminished the incidence of this injury in football in contrast to rugby
where the occurrence rate remains higher.
A shoulder separation is quite painful, and the athlete is unable to lift his arm without discomfort. The A-
C joint is swollen and tender to touch. Complete separations produce a prominent deformity with an
enlarged “bump.” If there is any doubt about the diagnosis, stress x-rays can be performed to confirm
that the joint has separated. The patient is asked to hold a heavy weight with the arm at the side. The
weight pulls the shoulder blade down, and the collarbone will displace upward.
Like many other orthopaedic injuries, A-C separations are categorized into three degrees of severity. A
first degree separation is merely a sprain without serious ligament damage. The joint is tender and
swollen, but there is no separation. Treatment consists of ice applications and use of a sling for 3-7
days. Athletics can later be resumed when the pain subsides, and full shoulder motion is restored.
Little rehabilitation is necessary, and the prognosis is excellent.
In the second degree separation, the injury is greater, and there is complete disruption of the ligaments
which surround the A-C joint. However, the ligaments holding the collarbone to the shoulder blade are
not torn, and consequently there is only minor displacement of the collarbone. The A-C “bump” is more
prominent, and the separation can be felt. This injury is also treated with a sling, but immobilization is
required for two to three weeks to allow the joint to heal. During this period, gentle motion exercises are
allowed to prevent shoulder stiffness. Later, shoulder strengthening exercises are recommended. The
athlete can return to sports in four to six weeks if the pain has subsided, and if there is clinical evidence
of healing.
A third degree A-C separation represents a complete dislocation of the joint and rupture of all
ligaments. The collarbone displacement produces a large painful deformity. The treatment of this injury
is controversial. Some orthopaedists believe that no treatment is necessary, and therefore no attempt is
made to reduce the separation. The rationale of this treatment is based on the belief that the
separation does not really cause any permanent disability of the shoulder after the initial pain has
subsided. The patient rests with a sling for one to two weeks and later resumes activity when there is no
longer any pain. There is merit to this approach, as many patients regain useful function of their
shoulder even with a permanent deformity.
The other school of thought is that the separation must be set and held either with a brace or by
surgery. The brace is a special sling with a pad which exerts pressure over the collarbone, pushing it
down. The sling could be effective, but it is very uncomfortable and must be worn constantly for six
weeks. Unfortunately, this treatment requires a rather stoical and reliable patient and, frequently, this
treatment option is not practical.
Surgery consists of returning the collarbone to its normal position and holding it in place with a screw,
pin, or wire. The ruptured ligaments are also repaired. The athlete will miss competition for
approximately 12 weeks.
However, surgery may be performed in certain instances—depending on the severity of the
displacement and individual requirements of the athlete relating to his sport.
CROSS SECTION OF THE SHOULDER
A-C JOINT
Shoulder separations refer to a disruption of the ligaments which hold the collarbone to the shoulder
blade. When these ligaments are ruptured, the collarbone rises out of place from the shoulder and
“separates.” Medically, this is referred to as an Acromio-Clavicular separation. As the clavicle
(collarbone) attaches to the acromion (side extension of the shoulder blade), it is held by three
ligaments. These ligaments stabilize the clavicle and hold it down toward the top of the chest. Injury to
these ligaments “springs” the collarbone upward from its normal position.
Run your hand along your collarbone; as the shoulder is approached, you will feel a small bump—this is
the acromio- clavicular (A-C joint). A-C separations usually occur from a direct force as one falls
violently onto the point of the shoulder. The shoulder is forced downward as the ligaments holding the
collarbone tear. The injury is common in contact sports, such as football, rugby, hockey, and lacrosse.
Football players who carry the ball, such as backs and ends, are more susceptible because their
shoulders are directly hit when they are tackled. However, the improvement and effectiveness of
shoulder pads over the years has diminished the incidence of this injury in football in contrast to rugby
where the occurrence rate remains higher.
A shoulder separation is quite painful, and the athlete is unable to lift his arm without discomfort. The A-
C joint is swollen and tender to touch. Complete separations produce a prominent deformity with an
enlarged “bump.” If there is any doubt about the diagnosis, stress x-rays can be performed to confirm
that the joint has separated. The patient is asked to hold a heavy weight with the arm at the side. The
weight pulls the shoulder blade down, and the collarbone will displace upward.
Like many other orthopaedic injuries, A-C separations are categorized into three degrees of severity. A
first degree separation is merely a sprain without serious ligament damage. The joint is tender and
swollen, but there is no separation. Treatment consists of ice applications and use of a sling for 3-7
days. Athletics can later be resumed when the pain subsides, and full shoulder motion is restored.
Little rehabilitation is necessary, and the prognosis is excellent.
In the second degree separation, the injury is greater, and there is complete disruption of the ligaments
which surround the A-C joint. However, the ligaments holding the collarbone to the shoulder blade are
not torn, and consequently there is only minor displacement of the collarbone. The A-C “bump” is more
prominent, and the separation can be felt. This injury is also treated with a sling, but immobilization is
required for two to three weeks to allow the joint to heal. During this period, gentle motion exercises are
allowed to prevent shoulder stiffness. Later, shoulder strengthening exercises are recommended. The
athlete can return to sports in four to six weeks if the pain has subsided, and if there is clinical evidence
of healing.
A third degree A-C separation represents a complete dislocation of the joint and rupture of all
ligaments. The collarbone displacement produces a large painful deformity. The treatment of this injury
is controversial. Some orthopaedists believe that no treatment is necessary, and therefore no attempt is
made to reduce the separation. The rationale of this treatment is based on the belief that the
separation does not really cause any permanent disability of the shoulder after the initial pain has
subsided. The patient rests with a sling for one to two weeks and later resumes activity when there is no
longer any pain. There is merit to this approach, as many patients regain useful function of their
shoulder even with a permanent deformity.
The other school of thought is that the separation must be set and held either with a brace or by
surgery. The brace is a special sling with a pad which exerts pressure over the collarbone, pushing it
down. The sling could be effective, but it is very uncomfortable and must be worn constantly for six
weeks. Unfortunately, this treatment requires a rather stoical and reliable patient and, frequently, this
treatment option is not practical.
Surgery consists of returning the collarbone to its normal position and holding it in place with a screw,
pin, or wire. The ruptured ligaments are also repaired. The athlete will miss competition for
approximately 12 weeks.
However, surgery may be performed in certain instances—depending on the severity of the
displacement and individual requirements of the athlete relating to his sport.
CROSS SECTION OF THE SHOULDER
A-C JOINT
SHOULDER SEPARATIONS By Edward Staub, M.D. |
| The following medical articles are intended only for general patient information and education. They are not necessarily specific to any one patient's needs and, therefore, should not be construed as formal medical advice or treatment. Obviously, if you have a similar medical problem, you should consult a physician and not rely on these articles in lieu of treatment. If you reside in Dr. Staub's area, he will be delighted to accept you as a patient, but his ultimate opinion and recommendations will be based on his personal examination of you. |
| Edward Staub, M.D. drstaub.com |
Orthopaedic Surgeon, Sports Medicine, Knee, Hip, Shoulder, Ankle, Spine
