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SHOULDER SEPARATION
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What is it?
A shoulder separation is an injury to the acromioclavicular (AC) joint, which is located at the end of the collar bone (clavicle) on top of the shoulder. They are also called AC sprains or separations. There are several ligaments which hold the AC joint together. Shoulder separations are graded I-VI depending on the degree or injury and deformity.

Causes
The most common cause of a shoulder separation is landing on either the side or top of the shoulder with the arm at the patient’s side. In hockey, it commonly occurs when a player is driven in the boards, striking the point of the shoulder. This occurs in other contact/collision sports and in activities where high-energy falls are common, such as skiing and cycling.

Risk Factors
• Participation in contact and collision sports
• Poor balance and coordination
• Prior shoulder separation

Symptoms
• Pain on top of the shoulder
• Pain with movement of the shoulder
• New bump or prominence on top of the shoulder

Diagnosis
Shoulder separations can be accurately diagnosed by a medical professional with experience in sports medicine. A sports medicine physician will perform a physical exam to evaluate for deformity, locate the source of pain, and test the range of motion and strength of the shoulder joint. X-rays will be performed to assess position of the bones and to check for fractures. Ultrasound, CT scan, or MRI scan may be ordered to further evaluate the injury, but advanced imaging is not typically required early on.

Treatment
Initial treatment consists of ice, pain medication, taping and padding, and placing the shoulder in a sling for comfort. Type I and II injuries do not require surgery. Once pain is controlled, the athlete should begin range of motion and strength exercises. Cortisone injections are sometimes used to improve pain in chronic injuries. Return to sports is possible once the athlete has good pain control and has regained normal range of motion and strength. Type III injury management is controversial, but most are treated non-operatively. Surgery is usually reserved for throwing athletes who injure their dominant arm. Evaluation by a sports medicine specialist is best to guide the ultimate treatment plan. Injury types IV-VI are handled operatively. Prompt surgical referral is preferred for optimal management.

Injury Prevention
The best way to prevent future shoulder separations is to fully rehabilitate an original injury. There are no known measures that can help prevent a first time injury.

Return to Play
Athletes with shoulder separations may be limited from sports participation for several weeks after the injury. Return to sport depends on the severity of the injury. In general, athletes may return to play when pain improves, shoulder movement is normal, and arm strength is normal.

AMSSM Member Authors: Kyle Goerl, MD, Robert Dimeff, MD

References:
Quillen DM, Wuchner M, Hatch RL. Acute shoulder injuries. Am Fam Physician. 2004 Nov 15;70(10):1947-54.

Epstein D, Day M, Rokito A. Current concepts in the surgical management of acromioclavicular joint injuies. Bull NYU Hosp Jt Dis. 2012;70(1):11-24.

Category: Shoulders,

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