Separations of the Shoulder

What is a separated shoulder?
Often confused with a dislocated shoulder, the separated shoulder actually is an injury to the end of the clavicle (collarbone) where it connects with the acromion (tip of the shoulder blade). Thus, the injury to the acromioclavicular (AC) joint involves a tear of the ligaments (acromio-clavicular and coracoclavicular) that connect the two bones. This type of injury is generally seen when a person takes a spill and falls directly on the shoulder, such as someone falling from a bike or a football player being tackled. There can also be associated nerve injuries, since large nerves run underneath the end of the clavicle.

Treatment
Treatment consists of placing the injured shoulder in a sling. Your doctor will prescribe medication to help with the pain. Passive range-of-motion exercises are used to maintain flexibility. Those who don't require surgery usually heal in 4 to 6 weeks and can have a visible, residual bump at the end of the clavicle.

When is surgery required?
In more severe injuries where the ligaments to the surrounding bones are completely torn, the clavicle is displaced upward, and it becomes quite painful to do any overhead activity. Surgery in these cases is usually recommended, especially in overhead throwing athletes (such as quarterbacks and pitchers) and people who use their shoulder in doing overhead work (such as painters and construction workers). The end of the clavicle is removed (resected) to prevent any degeneration or other disease of the joint.

Look on the bright side
Those who require surgery for severely displaced injuries often have good results from the repair. Surgical repair consists of using the remaining ligament (coracoclavicular ligament) to bring the clavicle back down and reinforcing the repair with sutures or wires. This will keep the clavicle in its proper position relative to the acromion. Passive range-of-motion exercises are started, but overhead activity is usually delayed for about 6 weeks after surgery. Patients are advised to avoid contact activities for 9 months after the operation. Anatomic repair of the main ligaments involved has a good success rate, and patients are usually able to return to their previous level of work or sports.

Next time you meet someone who has recently separated his or her shoulder, give them much-deserved sympathy and a handshake, but don't expect a high five!

William R. Sutton, M.D.
Wilmington, North Carolina