AC joint separation grade 3 successful rehab protocol
AC joint separation grade 3 successful rehab protocol

Shoulder separation (AC separation) is a common injury that occurs when the collarbone separates from the upper part of the shoulder blade (acromion). The acromioclavicular joint (AC joint) is where the clavicle meets the highest point of the acromion.

Shoulder separation typically occurs when the arm is forcefully twisted outward while above the shoulder, tearing the acromioclavicular and the coracoclavicular (CC) ligaments. These shoulder injuries often occur as a result of falling, a direct blow to the shoulder, or lifting heavy objects.

AC separations are common in direct contact sports, such as football and hockey, but can occur in various situations at any age. A shoulder can become partially dislocated (subluxation) or completely dislocated, in which the ball of the arm comes completely out of the socket.

Shoulder separation is classified by the degree of torn ligaments involved:

  • Grade I: Minor displacement of the joint in which the AC ligament is stretched or partially torn, but the CC ligament is not injured. This is the most common type of AC joint injury.
  • Grade II: Partial dislocation of the joint in which the AC ligament is completely torn, while the CC ligament is uninjured or only partially torn.
  • Grade III: Complete separation of the joint in which the AC and CC ligaments are completely torn, and the clavicle and the acromion are completely separated. A bump is often visible on the shoulder where the clavicle is pushed up.
  • Grades IV –VI are uncommon and usually involve tears in the deltoid and trapezius muscles requiring surgery.

Shoulder dislocations can be a recurring problem after tendons, ligaments, or muscles become loose or torn.

Symptoms of Shoulder Separation (AC Separation)

Shoulder separation symptoms vary depending on the degree of injury, but may include:

  • Acute pain at time of injury
  • Pain and swelling over the top of shoulder
  • Bruising
  • Tenderness to the touch
  • Limited mobility in the shoulder
  • Visible bump on top the shoulder

A shoulder injury of Grade III will generally be accompanied by pain with any arm motion, causing the patient to support the elbow and hold the arm close to the side.

Diagnosing Shoulder Separation

Shoulder separation is a common injury that occurs when the collarbone separates from the upper part of the shoulder blade (acromion). The acromioclavicular joint (AC joint) is where the clavicle meets the highest point of the acromion.

Diagnosing an AC separation will involve a physical examination in which your doctor will most likely:

  • Compare the position of the injured arm and shoulder to the uninjured side.
  • Feel the bones and soft tissue around the AC joint and between the acromion and clavicle.
  • Evaluate range of motion.
  • Examine the shoulder to identify a bump or deformity.
  • Isolate specific areas of pain and weakness.
  • X-ray the area to determine separation or fracture (may include an x-ray of the uninjured shoulder for comparison).

Treatment for Shoulder Separation

Treatment of AC separation depends on the severity of the injury. Shoulder injuries Grades I and II usually do not require surgery, while a Grade III injury can require surgical repair if the injury does not heal properly with other treatments. Shoulder separation treatment typically involves:

  • Managing pain
  • Supporting the shoulder
  • Reestablishing strength and range of motion (physical therapy)
  • Pain management usually includes:
  • Ice or cold packs: Helps with swelling, reducing pain.
  • Sling: Immobilizing the arm for a few days keeps the pain level down.
  • Use of non-steroidal anti-inflammatory drugs (NSAIDs): Medications such as aspirin and ibuprofen.

Orthopedic Surgery for Shoulder Separation

An AC separation may require surgery if it is considered to be a Grade III injury which has not responded well to non-surgical treatments, with pain persisting for 2-3 months. Other patients who may be considered for early surgery are:

  • Highly active individuals
  • Manual laborers whose jobs require heavy overhead work
  • Athletes with frequent, stressful overhead movement

Shoulder Arthroscopy

Shoulder arthroscopy is a minimally invasive surgical procedure in which a tiny camera (arthroscope) is used to identify and repair damaged tissue inside and around the shoulder joint. Arthroscopy is a highly advanced technique resulting in:

  • Smaller incisions
  • Shorter recovery times
  • Less pain and stiffness
  • Fewer complications

Recovering from Shoulder Separation

Recovering from shoulder separation depends on the severity of the injury and the type of treatment administered. Most patients with an AC separation experience a full recovery, although may have a residual bump left on the shoulder. Typical recovery times are:

  • Grade I: Approximately 2 weeks
  • Grade II: Approximately 6 weeks
  • Grade III: Up to 12 weeks for non-surgical patients

Surgical patients may have longer recovery times with restrictions on lifting and overhead motions for up to 12 weeks. Athletes may be restricted from throwing for 4-6 months. Physical therapy for 6-8 weeks is typical to regain full range of motion.

Our goal at OSMI is to provide our patients quality, cutting-edge orthopedic treatments, both surgical and non-surgical. Dr. Michael Boothby, having performed hundreds of successful arthroscopic surgeries, is consistently rated as one of The Top Orthopedic Surgeons in the Fort Worth area. If you have questions or concerns about joint pain, or for more information about arthroscopic surgery, please submit an online appointment request or contact our office at 817-529-1900.

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