3 Grades of Separated Shoulder: Diagnosis and Treatment

Separated Shoulder Anatomical Diagram
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A separated shoulder involves perhaps one of the hardest joints in the body to pronounce, the acromioclavicular joint, known as the “AC joint”. This joint has a very important job. Because of the complex nature of this joint, it’s often subjected to injury.

We’ll discuss what the AC joint is, what a separation is, why it happens, and what you can do to help heal yourself if it happens to you.

WHAT IS THE AC JOINT?

Simply put, it’s a major structural support that connects the acromion of the scapula (shoulder blade) to the clavicle (collar bone), the joint and its tissue are responsible for supporting the larger shoulder joint and helps it achieve full range of motion.

With such a complex structure and important role, injuries from misuse or overuse tend to plague the joint. Just think of how many friends and family members you know that used to play sports and now have serious shoulder issues. It’s a good bet the AC Joint may be involved!

If you’re having issues with your AC joint, the most common injury is AC joint separation, more commonly knows as separated shoulder. Separation has varying degrees and can be caused by a number of mechanisms. https://charmaustin.com/where-is-your-pain/#shoulderpain

WHAT IS A SEPARATED SHOULDER?

When you hear about a separated shoulder, it’s really the AC joint that is separated, caused by a dislocation of the clavicle (collar bone) from the scapula (shoulder blade).

An AC or shoulder separation is very common in contact sports. Football and hockey players, as well as cyclists who flip over their handlebars and land on the point of the shoulder, are usually the most frequent sufferers of this type of injury.

3 GRADES OF SEPARATED SHOULDER

Separated Shoulder Anatomical Diagram
  • Grade I- mild shoulder separation. This involves a sprain of the AC ligament that does not move the collarbone and looks normal on X-rays.
  • Grade II – a tear in the AC ligament, and/or a sprain or slight tear in the coracoclavicular (CC) ligament. This puts the collarbone slightly out of alignment, and you may see a visible bump.
  • Grade III- The most severe shoulder separation. This completely tears both the AC and CC ligaments and puts the AC joint noticeably out of position, with a larger bump. 

SEPARATED SHOULDER SYMPTOMS

  • Swelling, tenderness, or pain over/above the joint
  • Visible bump above the shoulder
  • Loss of strength or motion
  • Pain when lying on one’s side
  • Popping or catching sensations with the movement of the shoulder
  • Discomfort with daily activities that stress the shoulder such as reaching, lifting or carrying something.

HOW TO TREAT A SEPARATED SHOULDER

TRADITIONAL METHODS

Most of the injuries involving the AC Joint will not require invasive treatment or surgery. The following are what traditional medicine recommends. Most Grade I – III AC separations are treated successfully with non-surgical treatment that may include:

  • Ice to reduce pain and swelling
  • Rest and a protective sling until the pain subsides in roughly 1-2 weeks
  • Pain and anti-inflammatory medications
  • A rehabilitation program, such as structured physical therapy (PT) to help restore normal motion and strength. The shoulder joint is a complex joint and requires activation of the supporting joints and muscles in a proper sequence. This sequence can be lost if there is disruption in the chain of joints and muscles that make the shoulder work, cervical spine (neck) issues, presence of pain and any associated postural issues. https://charmaustin.com/restore-function-and-return-to-living/

Here’s an example of a technique that addresses some of these factors…

SHOULDER BLADE SCOOPING https://www.youtube.com/watch?v=tul2HNBT_Zw

The scoop method is a postural cue. This particular movement activates the musculature of the shoulder girdle to help promote proper alignment. What that means in basic terms is this strengthens the muscles surrounding the shoulder in order to allow your shoulder to sit in the proper position and therefore function properly.

When shoulders are rounded forward this will put unnecessary strain on the joint leading to dysfunction, discomfort, pain, and sometimes inflammation. Over time this can weaken the tissue setting us up for an injury such as a shoulder separation, bursitis, arthritis, rotator cuff strain, etc.

Scooping is NOT a substitute for supervised PT and is only an example of the helpful rehabilitation techniques that are out there.

Eduardo R. Elizondo, MD, CLCP

Fellow, American College of Sports Medicine

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