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Separated Shoulder

Definition :
Your shoulders are your body's most mobile joints. But the ability to move in many directions can leave your shoulders prone to injury.

The top of your shoulder blade (acromion) meets the end of your collarbone (clavicle) at the acromioclavicular (AC) joint. A stretch or tear of the ligaments of this joint — often due to a fall directly on the shoulder — is known as a separated shoulder. By contrast, a dislocated shoulder is a more extensive injury in which the upper arm bone (humerus) pops out of its cup-shaped socket.

Conservative treatment — such as rest, ice and medication — 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. A separated shoulder doesn't usually require surgical intervention.

Causes:
The most common cause of a separated shoulder is a blow to the shoulder or a fall directly on the 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.

Risk Factor :
Anyone at risk of falling on the shoulder is 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.

When to seek medical advice :
Contact your doctor if you experience tenderness or pain near the end of your collarbone — especially if lifting the affected arm with the other arm eases the pain. In the meantime, apply ice to the affected shoulder. If you're in pain, take an over-the-counter pain reliever.

Symptoms:
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 the shoulder

Diagnosis:
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 the collarbone is separated from the shoulder. At grade I, you may have discomfort but not actual separation. At grade II, there's a slight separation. At grade III, both the acromioclavicular and nearby coracoclavicular ligaments are completely torn.

Complication :
Most people fully recover from a separated shoulder. 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
  • The cartilage that separates and cushions the shoulder bones is damaged
Treatment:
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 10 to 14 days. A more severe separation may take six to eight weeks 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 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.

Prevention:
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.

 
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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