A shoulder separation is not truly an injury to the shoulder joint. The injury actually

involves the acromioclavicular joint (also called the AC joint). The AC joint is where

the collarbone (clavicle) meets the highest point of the shoulder blade (acromion).

 

The most common cause for a separation of the AC joint is from a fall directly onto

the shoulder. The fall injures the ligaments that surround and stabilize the AC joint.

 

If the force is severe enough, the ligaments attaching to the underside of the clavicle

are torn. This causes the separation of the collarbone and the shoulder blade. The

shoulder blade (scapula) moves downward from the weight of the arm, creating a

bump or bulge above the shoulder.

The injury can range from a mild sprain without a bump to a complete disruption with a very large bump. Good pain-free function often returns even with a very large bump. 

• A mild shoulder separation involves a sprain of the AC ligaments that does not move the collarbone and looks normal on X-rays.

• A more serious injury tears the AC ligaments and sprains or slightly tears the coracoclavicular (CC) ligament, putting the collarbone out of alignment to some extent with a smaller bump.

• The most severe shoulder separation completely tears both the AC and CC ligaments and puts the AC joint noticeably out of position, with a larger bump.

 

The injury is easy to identify when it causes deformity.

When there is less deformity, the location of pain and X-rays help the doctor make the diagnosis. Sometimes having the patient hold a weight in the hand can increase the deformity, which makes the injury more obvious on X-rays.

 

Treatment of this type of injury can involve icing, strapping, medications and Physiotherapy, but early intervention is key to eliminate the areas which will have reacted by becoming tight, thus increasing the pull on the injured area. The main goals of early treatment would be to maximise blood flow, release tension in tight structures and improve overall strength. Recovery could be anything from a couple of weeks for a mild strain to several months for a major strain, but this is not a hard and fast rule. Most athlestes return to full function, including rugby players.