Separated Shoulder (Acromioclavicular Separation)

Shoulder separation is a condition caused by dislocation of the acromioclavicular joint (AC joint), which is located between the top of the shoulder (acromion) and the collarbone (clavicle), due to injury of ligaments stabilizing the joint. This type of injury occurs, for example, due to a direct blow to the shoulder, a fall on the shoulder, or a fall on an outstretched hand. The severity of injury is graded using two classification systems (Tossy Type I-III, Rockwood Type I-VI). Patients with shoulder separation feel marked pain in the shoulder after the injury and tend to cradle the arm protectively against the body. The top of the shoulder is tender and visibly swollen in most cases.

Diagnosis:

Depending on the severity of damage to the ligaments, it may be possible to elicit the so-called "piano key sign". This is done by pressing down on the outer edge of the clavicle, depressing the clavicle like a key on a piano. If the bone pops back up when released, then the sign is positive.
If a separated shoulder is suspected, X-rays of both shoulders will be obtained with the patient holding weights in each hand (these are called "panoramic X-rays"). By comparing the two sides, the physician can determine the severity of the injury and detect any differences in the healthy and injured side.

Treatment:

There are two basic approaches to treatment of separated shoulder: conservative and surgical.

Conservative Treatment:

Conservative treatment is performed if the ligaments of the acromioclavicular joint are intact or simply overstretched. This includes:

Rest with or without a sling for immobilisation of the joint, as needed
Ice
Medications to reduce pain and inflammation
Physiotherapy, if needed

Surgical Treatment:

Surgery is generally performed if the ligaments are torn. There are various surgical options available for immobilisation of the AC joint (e.g. sutures, metal plates, traction devices, and screws). With your input, we will determine which method is best for you in order to achieve the optimal surgical outcome.

Procedure:

On the day after surgery, mobilisation exercises will be started with the assistance of a physical therapist, and you can generally leave the hospital in about 3 to 4 days.
Physiotherapy should be continued on an outpatient basis in order to re-establish shoulder strength and range of motion. Naturally, you will be requested to return to our practice for follow-up at regular intervals.