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Shoulder Separation

Topic Overview

What is a shoulder separation?

A shoulder 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:

  • In a type I injury, the AC ligament is partially torn, but the CC ligament is not injured. See a picture of a type I injury.
  • In a type II injury, the AC ligament is completely torn, and the CC ligament is either not injured or partially torn. The collarbone is partially separated from the acromion. See a picture of a type II injury.
  • In a type III injury, both the AC and CC ligaments are completely torn. The collarbone and the acromion are completely separated. See a picture of a type III injury.

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).

What causes a shoulder separation?

A direct 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.

What are the symptoms?

Signs and symptoms of a shoulder separation include:

  • Pain at the moment the injury occurs.
  • Limited movement in the shoulder area (because of pain, not weakness).
  • Swelling and bruising.
  • Tenderness over the AC joint on top of the shoulder.
  • Possible deformity. The outer end of the collarbone may look out of place, or there may be a bump on top of the shoulder.

How is a shoulder separation diagnosed?

A shoulder separation is diagnosed through a medical history, a physical exam, and an X-ray.

Your doctor will check:

  • For a deformity or bump.
  • The range of motion of your shoulder and other joints.
  • Blood flow, by taking your pulse and assessing your skin color and temperature.
  • For damage to your nerves or blood vessels.
  • The muscle strength of your shoulder and arm.
  • For broken shoulder bones or damage to the tendons in the shoulder (rotator cuff tear).

Your doctor will probably X-ray your injured shoulder and possibly your uninjured shoulder to help diagnose the severity of the separation.

How is it treated?

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.

Other Places To Get Help

Organizations

American Academy of Orthopaedic Surgeons (AAOS)
6300 North River Road
Rosemont, IL  60018-4262
Phone: (847) 823-7186
Fax: (847) 823-8125
Email: orthoinfo@aaos.org
Web Address: www.orthoinfo.aaos.org
 

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.



Move Forward
1111 North Fairfax Street
Alexandria, VA 22314-1488
Phone: 1-800-999-APTA (1-800-999-2782)

(703) 684-2782
Fax: (703) 684-7343
TDD: (703) 683-6748
Web Address: www.apta.org
Web Address: www.moveforwardpt.com
 

The American Physical Therapy Association (APTA) Move Forward website provides information and education to the public about physical therapy and how it is used to treat certain conditions. APTA is a national organization representing over 85,000 physical therapists, physical therapist assistants, and students. APTA's goal is to foster advancements in physical therapist education, practice, and research.



National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health
1 AMS Circle
Bethesda, MD  20892-3675
Phone: 1-877-22-NIAMS (1-877-226-4267) toll-free
Phone: (301) 495-4484
Fax: (301) 718-6366
TDD: (301) 565-2966
Email: niamsinfo@mail.nih.gov
Web Address: www.niams.nih.gov
 

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.



Related Information

References

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.

Credits

By Healthwise Staff
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP - Emergency Medicine
Specialist Medical Reviewer Patrick J. McMahon, MD - Orthopedic Surgery
Last Revised August 29, 2011

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