A separated shoulder is an injury to the ligament holding the collarbone, or clavicle, and the shoulder blade, called the scapula, together. The two, as well as the arm bone, are held together by the acromioclavicular (AC) joint. The clavicle and scapula form the socket into which the arm bone, or humerus, fits. If the clavicle and scapula are suddenly pushed together, injury to the joint can occur.
Frequently, this type of injury is the direct result of either blunt force injury to the shoulder, like a hit to the shoulder when playing football, or a fall onto a hand pushed in front of the body. Either injury can smash the clavicle and scapula together and cause damage to the ligament.
Normally, a healthcare professional diagnoses a separated shoulder by listening to how the injury occurred and by taking X-rays to determine the extent of injury. In mild cases, the damage may not be visible on an X-ray, but even a mild case usually causes extreme pain.
There are actually five grades of separated shoulder that are determined based on the severity of injury, and they also help determine treatment for the condition. In Type I, there is minimal damage, if any, to the ligament, but the capsule around the AC joint is swollen. Type II shows some damage or partial tearing to the ligament and damage to the AC joint. Type III is a more exaggerated form of Type II, with more ligament and AC joint damage. Type IV indicates that the clavicle has been displaced and is now behind the AC joint. Type V, which is quite rare, indicates that the clavicle has been pushed below the scapula.
In Type I and II injuries, treatment involves slinging the arm for about two weeks. This, icing the shoulder, and taking anti-inflammatory medication usually help the injury to heal on its own in a relatively short period of time. Intense pain during the first few days may also be addressed with narcotic pain relievers like codeine.
Type III separated shoulder may also be treated as Type I and II. Some argue for repairing the ligament surgically, and either stitching or using screws to keep the AC joint held together to promote better healing. Many find that using a sling is just as effective, however, and does not involve the risks associated with surgery.
Type IV and V must be addressed surgically in order to reposition the clavicle. This may require much longer recovery time, as well physical therapy to regain full use of the joint. There are many variations of surgery that may treat this degree of injury, and the goal of any of these operations is to restore the AC joint and repair the damaged ligament.
Occasionally, additional surgery may be required if any of the bones involved are broken. Bones may need to be reset, but casting this area is difficult. Sometimes, pins or heavy stitching are inserted to help the bones heal normally.
After surgery, the shoulder is usually kept in a sling for several weeks before the patient begins physical therapy to regain use of the joint. Many recover completely from surgery. A few, however, may have lasting complications or loss of some function in the joint.
