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A/C joint separations

A direct blow to the shoulder can separate the A/C joint, which can cause a lot of shoulder pain. This injury most commonly occurs in sports when an athlete falls and hits the ground with the tip of the shoulder. Rough contact sports like football, rugby, and ice hockey are also very common causes of A/C joint separations. When the A/C joint is separated, the capsule and ligaments that surround the joint have been torn and the ends of the acromion or the clavicle are not in the proper position.

Doctors have a system for categorizing A/C separations by how far apart the ends of the bones are separated on an x-ray. This system is also used to describe how much damage has been done to the ligaments that stabilize the joint.

  • In type I injuries, the capsule and ligaments of the A/C joint have been sprained but not completely torn.
  • In type II injuries, the acromio-clavicular ligaments have been completely torn, but another ligament between the clavicle and a part of the scapula called the coracoid process (the coraco-clavicular ligament) is still intact.
  • In type III injuries, both of these ligaments have been completely torn.

Grade I - A/C Sprain

Grade I A/C Sprain

Grade II - A/C Separation

Grade II A/C Separation

Grade II - A/C Separation

Grade III A/C Separation

 

There are several other types of A/C joint separations, according to the direction of the dislocation of the clavicle, but nearly all A/C separations fit into one of these first three categories. After an A/C joint separation, the tip of the clavicle can stick up and create a noticeable bump on front of the shoulder.

After an A/C joint separation, the tip of the clavicle can create a noticable bump.

 

What can be done for an A/C joint separation?

Acromio-clavicular separations can be very painful, especially right after the injury. However, the good news is that most of these injuries can be treated without surgery. The first goal of treatment is to make the patient comfortable, by placing the arm in a sling and applying an ice pack to the shoulder. Mild pain medications are all that should be required to take away most of the shoulder pain. The amount of pain that is produced by this injury is dependent upon how bad the injury was in the first place, with higher grade injuries producing more pain and discomfort. Over the first week or so, the shoulder pain will begin to fade away and it is important to start moving the entire arm and shoulder as much as possible in order to prevent the joints from becoming stiff. Your doctor, physical therapist, or trainer will be able to help you with deciding when to start moving your arm and what kind of exercises you can do.

The amount of time that it takes to get back your normal motion and use of the arm depends upon how severe the injury was. As a general guideline, a grade I injury takes ten to fourteen days to heal before the shoulder can be used without a lot of pain. A grade III injury can take much longer, between six and eight weeks, while a grade II injury should heal somewhere in between. This process of gradually returning to your normal activities as the shoulder pain subsides is the way that more than ninety-five percent of A/C separations are treated.

Why would I need surgery for an A/C joint separation?

Most grade I, II and even grade III injuries do not need surgery. Grade I and II injuries will heal without creating a large bump on the front of the shoulder. Grade III injuries will also usually heal themselves, but with these injures, the bump that is created by the tip of the clavicle is often more noticeable. There are some surgeons who will recommend shoulder surgery for serious athletes, especially those who are throwing athletes, like baseball pitchers. People who make their living doing very hard manual labor may also benefit from surgery. Rarely, the clavicle will be so far out of place that it will feel very uncomfortable or unstable, even after the injury has completely healed. In these cases, surgery is recommended to bring the joint back into proper alignment. Some people are very concerned about the way that an A/C separation looks after it heals, and surgery can be used to put the joint back in its proper alignment. Because this does require a small incision, some patients view this type of surgery as "trading a bump for a scar".

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