A separated shoulder is an injury to the ligament that holds the clavicle and shoulder blade together. It is caused by a blunt force injury to the shoulder and is diagnosed by a healthcare professional. Treatment varies depending on the severity of the injury, with types I and II being treated with a sling, ice, and anti-inflammatory drugs, while types IV and V require surgery and physical therapy.
A separated shoulder is an injury to the ligament that holds the clavicle, or clavicle, and shoulder blade together, called the scapula. The two, as well as the upper arm bone, are held together by the acromioclavicular (AC) joint. The collarbone and scapula form the socket into which the upper arm bone, or humerus, fits. If the collarbone and scapula are suddenly pushed together, injury to the joint can occur.
Frequently, this type of injury is the direct result of a blunt force injury to the shoulder, such as a blow to the shoulder when playing soccer, or a fall onto a hand pushed in front of the body. Both injuries can break the collarbone and scapula together and cause ligament damage.
Normally, a healthcare professional diagnoses a separated shoulder by listening to how the injury occurred and taking X-rays to determine the extent of the injury. In mild cases, the damage may not be visible on an X-ray, but even a mild case usually results in extreme pain.
There are actually five degrees of separated shoulder which are determined based on the severity of the injury and also help determine the treatment for the condition. In type I, there is minimal, if any, damage to the ligament, but the capsule around the AC joint is swollen. Type II shows some damage or partial tears to the ligament and damage to the AC joint. Type III is a more exaggerated form of type II, with more damage to the AC ligaments and joints. Type IV indicates that the clavicle has been moved and is now behind the AC joint. Type V, which is quite rare, indicates that the collarbone has been pushed under the scapula.
In type I and II injuries, treatment involves slinging the arm for about two weeks. This, ice on the shoulder and taking anti-inflammatory drugs usually help the injury heal on its own in a relatively short period of time. Severe pain during the first few days can also be addressed with narcotic pain relievers such as codeine.
Type III separated shoulder can also be treated as types I and II. Some advocate surgically repairing the ligament and stitching or using screws to hold the AC joint together to promote better healing. Many find that using a sling is just as effective, however, and doesn’t carry the risks associated with surgery.
Types IV and V must be addressed surgically to reposition the clavicle. This may require much longer recovery time, as well as physical therapy to regain full use of the joint. There are many variations of surgery that can treat this degree of injury, and the goal of each of these operations is to restore the AC joint and repair the damaged ligament.
Occasionally, further surgery may be needed if one of the involved bones is broken. Bones may need to be reset, but casting this area is difficult. Sometimes heavy pins or stitches are inserted to help the bones heal normally.
After surgery, the shoulder is usually held in a sling for several weeks before the patient begins physical therapy to reuse the joint. Many recover completely from surgery. Some, however, may have lasting complications or loss of some function in the joint.
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