A separated shoulder is a common injury that affects the joint connecting the collarbone and the shoulder blade. This type of injury is distinct from a dislocated shoulder, which involves a different part of the shoulder complex. This article explains what a separated shoulder entails, its typical symptoms, the grading system used for its severity, and the available treatment and recovery options.
Anatomy of a Separated Shoulder
A separated shoulder involves the acromioclavicular (AC) joint at the top of the shoulder. This joint forms where the collarbone (clavicle) meets the acromion, a part of the shoulder blade. Unlike a dislocated shoulder, which affects the glenohumeral joint, a separated shoulder impacts the AC joint’s stability.
The stability of the AC joint relies on two main sets of ligaments. The acromioclavicular (AC) ligaments connect the clavicle to the acromion, providing horizontal stability. Below these, the stronger coracoclavicular (CC) ligaments connect the clavicle to the coracoid process, offering vertical stability. Injury to these ligaments dictates the severity of a separated shoulder.
Common Causes and Symptoms
A separated shoulder most frequently results from a direct impact to the top or side of the shoulder. This often occurs during falls onto the shoulder, common in sports like cycling, football, or snowboarding, or from a direct blow.
Individuals report immediate, localized pain over the AC joint, along with swelling and tenderness. The injury can limit arm range of motion, making it difficult or painful to lift the arm overhead or across the body. In more severe cases, a visible bump or deformity may appear on top of the shoulder due to upward clavicle displacement.
Grades of Separation and Diagnosis
Separated shoulders are classified into grades based on the severity of ligament damage and clavicle displacement. Type I is the mildest, involving an AC ligament sprain with no tearing or joint displacement. Type II involves a complete AC ligament tear, often with partial CC ligament tearing, leading to slight upward clavicle displacement. Type III signifies a complete tear of both AC and CC ligaments, resulting in upward clavicle displacement from the acromion.
Higher grades (Type IV to VI) are less common, involving more severe clavicle displacement, sometimes even behind or below the acromion. Diagnosis begins with a physical examination by a healthcare professional. They will palpate the AC joint, assess range of motion, and perform stress tests to evaluate joint stability. X-rays are commonly used to confirm diagnosis and determine the grade of separation, sometimes involving stress X-rays where a weight is held to emphasize displacement.
Treatment Options
Treatment for a separated shoulder depends on the injury’s grade. For Type I and II separations, and often Type III, non-surgical (conservative) treatment is recommended. This approach involves rest, ice to reduce swelling, compression, and arm elevation. Pain management includes over-the-counter relievers, and a temporary arm sling may provide support during the initial healing phase.
Physical therapy is a component of conservative management once pain subsides, focusing on restoring range of motion and strengthening surrounding muscles. Surgical intervention is considered for higher-grade injuries (Type IV-VI) or some Type III separations, especially in active individuals or those with demanding occupations. The goal of surgery is to reconstruct or repair torn ligaments and stabilize the AC joint.
Recovery and Rehabilitation
Recovery for a separated shoulder varies depending on the injury grade and treatment method. Milder Type I and II injuries may recover within a few weeks to a couple of months. More severe injuries, such as Type III, or those requiring surgery, can take several months for full recovery.
Rehabilitation progresses through phases. Initially, the focus is on controlling pain, swelling, and protecting the healing joint. This is followed by restoration of the shoulder’s range of motion. Progressive strengthening exercises then rebuild muscle strength around the shoulder and improve overall stability.
Physical therapy plays a role throughout this process, helping individuals regain full function and prevent stiffness or chronic instability. Even after healing, some individuals with Type III injuries may retain a visible bump on the top of their shoulder.