Hartford HealthCare Sports Health sees dozens of shoulder-separation injuries each year, usually around football, hockey and lacrosse seasons. The great majority are treated non-operatively. Even mild or moderate injuries are well tolerated, once the acute pain/inflammation resolve. The ones that need surgery have significant displacement (Grade 5) and can cause moderate dysfunction of the shoulder.
Dr. Clifford Rios, Bone & Joint Institute orthopedic surgeon and board-certified in sports medicine.
What's The AC joint?
The acromioclavicular (AC) joint is the small joint, two bones, at the front the shoulder at the junction of the collarbone (clavicle) and the bone at the tip of the shoulder (acromion). Four ligaments hold the clavicle and acromion in place.
An AC joint sprain, or separation, occurs when the ligaments are stressed, either by trauma or overuse.
What's the difference between a shoulder separation and shoulder dislocation?: A shoulder separation affects the AC joint. Your shoulder is dislocated when the bone in your upper arm pops out of the socket at the shoulder blade.
Types Of AC Joint Injuries
Each of these most common classifications qualify as an AC joint sprain, or shoulder separation.
- Grade 1: A mild shoulder separation. Ligaments partially torn or stretched but no visible lump on the shoulder.
- Grade 2: A partial separation. The AC ligament is torn but the coracoclavicular ligaments, which stabilize the AC joint, are undamaged. A small lump is visible on the shoulder.
- Grade 3: A complete separation of the joint. The AC ligament and coracoclavicular ligaments are completely torn. A more pronounced bump is visible on the shoulder.
Whatever the severity, the injury rarely requires surgery.
"I see dozens of AC injuries each year," says Dr. Rios, "usually around football, hockey and lacrosse seasons. The great majority are treated non-operatively. Even mild or moderate injuries are well tolerated, once the acute pain/inflammation resolve. The ones that need surgery have significant displacement (Grade 5) and can cause moderate dysfunction of the shoulder."
Symptoms
Your doctor will suspect an AC joint sprain if you have:
- A visible lump above the shoulder.
- Loss of shoulder strength, movement.
- Swelling, bruising.
- Pain when lying on the injured side.
- A popping sound feeling that joint "catches" when moving the shoulder.
- Pain when lifting significant weight either overhead or across the body.
"Problems with the AC joint lead to pain with direct contact (like a collision to top of shoulder), reaching across body and reaching above shoulder level," says Dr. Rios.
Treatment
An AC joint injury is treated initially with PRICE therapy.
- Protection: Protect damaged tissue to prevent further damage.
- Rest: Stop training. Take it easy and allow time for healing. Check with your physical therapist before resuming exercise.
- Ice: The simplest and most effective treatment after the injury. It reduces bleeding and the risk of cell death. It will also reduce pain.
- Compression: Reduces swelling.
- Elevation: Drains fluid from the injury, reducing swelling and pain. Elevate the ankle above the hip.
An anti-inflammatory (example: ibuprofen) can reduce pain and swelling. Your doctor will recommend immobilizing the shoulder by placing it in a sling for up to three weeks -- or four weeks for a Grade 3 sprain. A Grade 3 sprain might require surgery. Broncos quarterback Trevor Siemian missed one week last season with left shoulder (non-throwing) Grade 3 separation but chose off-season surgery.
Taping the joint for two or three weeks is also an option to provide support as it heals.
"Elite players are going to get treatment," says Dr. Rios. "The AC joint does not contribute to mobility of the shoulder, so post-injury stiffness is not really an issue. Rehab goals will be stimulating muscles that do not cause pain so they don't get weak while waiting for the injury to recover."