separation is the partial or complete separation of two
parts of the shoulder: the collarbone (clavicle) and the end of the shoulder
blade (acromion). See a picture of
shoulder separation injuries.
The collarbone and the shoulder blade
(scapula) are connected by the
acromioclavicular (AC) joint, which is held together
primarily by the acromioclavicular (AC) and the coracoclavicular (CC)
ligaments. In a shoulder separation (also called an
acromioclavicular joint injury), these ligaments are partially or completely
torn. A shoulder separation is classified according to how severely these
ligaments are injured:
There are three further classifications, types IV through
VI, which are uncommon. These types of shoulder separations may involve tearing
of the muscle that covers the upper arm and shoulder joint (deltoid muscle) and the one that extends from the back
of the head, neck, and upper back across the back of the shoulder (trapezius muscle).
blow to the top of the shoulder or a fall onto the shoulder, such as
a fall from a bicycle, can cause a shoulder separation.
Signs and symptoms of a
shoulder separation include:
separation is diagnosed through a medical history, a physical exam, and
Your doctor will check:
Your doctor will probably X-ray your injured
shoulder and possibly your uninjured shoulder to help diagnose the severity of
Treatment of a
shoulder separation depends on its severity. For a
type I or II injury, you support your shoulder with a
sling. You typically need the sling until the
discomfort decreases (a few days to a week). Early physical therapy to
strengthen your shoulder and regain range of motion is important for recovery
and to prevent frozen shoulder, a condition that limits shoulder motion (adhesive capsulitis). You can return to normal
exercises and activities as your pain and other symptoms go away.
Treatment for type III injuries is controversial. Some doctors treat them with a sling and physical therapy, while others feel
surgery may be needed.
Type IV through VI injuries should be
evaluated for possible surgery.
To help relieve pain, put ice on
the affected area and take
nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen.
The American Academy of Orthopaedic Surgeons (AAOS)
provides information and education to raise the public's awareness of
musculoskeletal conditions, with an emphasis on preventive measures. The AAOS
website contains information on orthopedic conditions and treatments, injury
prevention, and wellness and exercise.
The American Physical Therapy Association is a national
organization representing nearly 70,000 physical therapists, physical therapist
assistants, and students. Its goal is to foster advancements in physical
therapist education, practice, and research. The APTA also provides information
and education to the public about physical therapy and how it is used to treat
The National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS) is a governmental institute that serves the public
and health professionals by providing information, locating other information
sources, and participating in a national federal database of health
information. NIAMS supports research into the causes, treatment, and prevention
of arthritis and musculoskeletal and skin diseases and supports the training of
scientists to carry out this research.
The NIAMS website provides
health information referrals to the NIAMS Clearinghouse, which has information
packages about diseases.
Other Works Consulted
McMahon PJ, Kaplan LD (2006). Acromioclavicular joint injury section of Sports medicine. In HB Skinner, ed., Current Diagnosis and Treatment in Orthopedics, 4th ed, pp. 212–213. New York: McGraw-Hill.
Mercier LR (2008). Acromioclavicular dislocation section of The shoulder. In Practical Orthopedics, 6th ed, pp. 75–76. Philadelphia: Mosby Elsevier.
August 29, 2011
William H. Blahd, Jr., MD, FACEP - Emergency Medicine
& Patrick J. McMahon, MD - Orthopedic Surgery
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