Shoulder Separation – An Odd Injury

What is it?

A shoulder separation sounds like an odd injury, but it refers to the over stretching or tearing of the ligaments which stabilizes the Acromioclavicular joint or AC joint, which is nothing but the joint formed at the meeting point of the collar bone and the shoulder blade. Injury to these ligaments lead to excessive prominence and abnormal mobility of the collar bone, most commonly in upward and outward direction.

What is the cause?

A shoulder separation is usually the result of an impact or blow to the front of the shoulder or by falling on an outstretched hand. Most common causes are road traffic accidents or fall from height.

Symptoms and signs

Shoulder pain while doing overhead activities, tenderness along the outer border of collar bone, bump noted on top of the shoulder, associated bruising and swelling are some of the common signs and symptoms. In cases with long duration of injury they may present with permanent deformity and severe restriction in overhead activities.

How to diagnose?

Shoulder separation can be diagnosed with standard X rays, which can further help us determine the type and severity of it based on the extent and direction of joint separation. They are of 6 types of which type 1 and type 2 are mild form and are treated conservatively. Type 3,4,5 and 6 are more severe and operative intervention is imperative.

What are the treatment options?

Type1 and type2 are managed with rest and immobilization with sling to allow the ligaments to heal along with anti-inflammatory medications. Further physiotherapy and exercises help achieve good strength and range of motion.

Type 3 and onwards, need surgical intervention, especially in those who are involved in heavy labour and play sports that require frequent overhead motions. The aim of the procedure is to realign and reattach the damaged or torn ligaments and allow it to heal. This can be achieved with both mini open or arthroscopic key hole surgeries. Both of which promote early recovery and better functional outcomes. Mini titanium buttons, biodegradable anchors, fibre wire and fibre tapes are commonly used to align and stabilize the collar bone in position. In cases with late presentation, ligament reconstruction is carried out using auto graft. Most shoulder separations heal within two to three months with no complications.

If left untreated?

It may lead to early arthritis of the AC joint, permanent deformity, loss of range of motion and shoulder strength due to abnormal biomechanics. Hence early diagnosis and management is must.

Dr Nikhil Manvi
MS Orthopaedics, Assistant Professor,
Joint replacement and Arthroscopy Surgeon