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Separated shoulder

A separated shoulder is an injury to one of your body's most mobile joints. The top of your shoulder blade meets the end of your collarbone at what is called the acromioclavicular joint. A separated shoulder is a stretch or tear of one or more of the ligaments of this joint.

A separated shoulder doesn't usually require surgery. Instead, conservative treatment — such as rest, ice and pain relievers — is often enough to relieve the pain of a separated shoulder. Most people regain full shoulder function within a few weeks after experiencing a separated shoulder.

Signs and symptoms of a separated shoulder may include:

• Shoulder pain
• Shoulder or arm weakness
• Shoulder bruising or swelling
• Limited shoulder movement
• A bump at the top of your shoulder

When to see a doctor
Contact your doctor if you experience tenderness or pain near the end of your collarbone — especially if lifting your affected arm with your other arm eases the pain.

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Separated shoulder

The top of your shoulder blade (acromion) meets the end of your collarbone (clavicle) at the acromioclavicular (AC) joint. A separated shoulder is a stretch or tear of one or more of the ligaments of the acromioclavicular joint.

The most common cause of a separated shoulder is a blow to your shoulder or a fall directly on your shoulder. The fall may stretch or tear the ligaments that stabilize the acromioclavicular joint. This separates the bones in the shoulder, creating a bump at the top of the shoulder.

If you're at risk of falling on your shoulder, you're at risk of a separated shoulder. The risk is particularly high for athletes — especially those who participate in contact sports, such as football and hockey, and in sports that may involve falls, such as downhill skiing, gymnastics and volleyball.

Most people fully recover from a separated shoulder with conservative treatment. Continued shoulder pain is possible, however, if:

• You have a severe separation that involves significant displacement of the collarbone
• You develop arthritis in your shoulder
• Other structures around your shoulder, such as the rotator cuff, are damaged

Preparing for your appointment
You're likely to start by first seeing your family doctor or a general practitioner. However, if your separated shoulder is severe, you may be referred to a doctor who specializes in bones and joints.

Because appointments can be brief, it's a good idea to come prepared for your appointment. Write down any symptoms you're experiencing and any questions you want to ask your doctor.

Your doctor will have questions for you, too. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• How severe is your shoulder pain?
• When did your shoulder pain begin?
• Do you know what triggered your symptoms? For instance, have you experienced a fall or participated in contact sports recently?
• What, if anything, seems to improve your pain?
• What, if anything, appears to worsen your pain?

What you can do in the meantime
Apply ice to the affected shoulder to reduce pain and swelling. If you're in pain, take an over-the-counter pain reliever.

Often, a separated shoulder can be identified during a physical exam. Your doctor may use an X-ray of the shoulder or other imaging studies to confirm the diagnosis and study the extent of the injury.

A separated shoulder is graded depending on how far your collarbone is separated from your shoulder:

• Type I. You may have discomfort but not actual separation.
• Type II. There's a slight separation.
• Type III. Both the acromioclavicular and nearby coracoclavicular ligaments are completely torn.
• Types IV, V and VI. These are the most severe tears, and they often require surgery.

A separated shoulder is usually treated conservatively. Your doctor may recommend:

• Rest. Avoid activities that aggravate your shoulder pain, especially crossing the affected arm in front of your body. You might want to temporarily immobilize your arm in a sling to take pressure off your shoulder and promote healing.
• Ice. Ice can reduce shoulder pain and swelling. Use a cold pack, a bag of frozen vegetables or a towel filled with ice cubes for 15 to 20 minutes at a time. Do this every couple of hours the first day or two, and then as often as needed.
• Medication. Over-the-counter pain relievers also can ease shoulder pain.
• Shoulder exercises. Physical therapy can help you restore strength and motion in your shoulder.

Most people enjoy a full recovery after conservative treatment — although the more severe the shoulder separation, the longer it'll take to regain comfortable use of your shoulder. A minor separation may heal within a few weeks. A more severe separation may take several weeks to months to heal. You may always have a noticeable bump on the affected shoulder, but it shouldn't affect your ability to use your shoulder.

If pain persists or if you have a severe separation, surgery might be an option. Surgery usually involves measures to stabilize the acromioclavicular joint and re-establish normal bony relationships in the shoulder.

• Avoid activities that aggravate your shoulder pain — especially contact sports — until your pain disappears. Gentle exercises can help keep your shoulder muscles limber, however.
• Use ice and over-the-counter pain relievers.
• Consider investing in special protection pads designed for athletes who've injured their acromioclavicular joint, if you decide to return to contact sports after your shoulder has healed.

Regular exercise, including strength training, can help you strengthen and protect your shoulders. Start slowly, and increase your intensity gradually. Use proper form and protective gear for your given sport.