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What is a Separated Shoulder?

A separated shoulder is when the ligament holding the collarbone and the shoulder together is damaged.
Type I and II separated shoulders are most frequently treated by putting the arm in a sling.
Type IV and V separated shoulders must be surgically repositioned so that the clavicle can heal.
A type III separated shoulder can be fixed using surgery to insert screws to keep the AC joint together.
The clavicle, also called the collar bone, connects the shoulder to the sternum.
Certain types of separated shoulders will require physical therapy.
Football players have a higher risk of separating a shoulder.
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  • Written By: Tricia Ellis-Christensen
  • Edited By: O. Wallace
  • Last Modified Date: 19 December 2014
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A separated shoulder is an injury to the ligament holding the collarbone, or clavicle, and the shoulder blade, called the scapula, together. The two, as well as the arm bone, are held together by the acromioclavicular (AC) joint. The clavicle and scapula form the socket into which the arm bone, or humerus, fits. If the clavicle and scapula are suddenly pushed together, injury to the joint can occur.

Frequently, this type of injury is the direct result of either blunt force injury to the shoulder, like a hit to the shoulder when playing football, or a fall onto a hand pushed in front of the body. Either injury can smash the clavicle and scapula together and cause damage to the ligament.

Normally, a healthcare professional diagnoses a separated shoulder by listening to how the injury occurred and by taking X-rays to determine the extent of injury. In mild cases, the damage may not be visible on an X-ray, but even a mild case usually causes extreme pain.

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There are actually five grades of separated shoulder that are determined based on the severity of injury, and they also help determine treatment for the condition. In Type I, there is minimal damage, if any, to the ligament, but the capsule around the AC joint is swollen. Type II shows some damage or partial tearing to the ligament and damage to the AC joint. Type III is a more exaggerated form of Type II, with more ligament and AC joint damage. Type IV indicates that the clavicle has been displaced and is now behind the AC joint. Type V, which is quite rare, indicates that the clavicle has been pushed below the scapula.

In Type I and II injuries, treatment involves slinging the arm for about two weeks. This, icing the shoulder, and taking anti-inflammatory medication usually help the injury to heal on its own in a relatively short period of time. Intense pain during the first few days may also be addressed with narcotic pain relievers like codeine.

Type III separated shoulder may also be treated as Type I and II. Some argue for repairing the ligament surgically, and either stitching or using screws to keep the AC joint held together to promote better healing. Many find that using a sling is just as effective, however, and does not involve the risks associated with surgery.

Type IV and V must be addressed surgically in order to reposition the clavicle. This may require much longer recovery time, as well physical therapy to regain full use of the joint. There are many variations of surgery that may treat this degree of injury, and the goal of any of these operations is to restore the AC joint and repair the damaged ligament.

Occasionally, additional surgery may be required if any of the bones involved are broken. Bones may need to be reset, but casting this area is difficult. Sometimes, pins or heavy stitching are inserted to help the bones heal normally.

After surgery, the shoulder is usually kept in a sling for several weeks before the patient begins physical therapy to regain use of the joint. Many recover completely from surgery. A few, however, may have lasting complications or loss of some function in the joint.

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anon348766
Post 19

In August 2013, I suffered a separated shoulder grade 3 (AC ligament and cruciate ligaments torn, so I had three shoulder ligaments torn, and my shoulder was down by a good inch and the collarbone was completely up. My scapula in the back moved a little bit too.) I had a motorcycle accident. I tumbled two or three times on the concrete at 45 mph.

At the hospital, they put my arm in a sling. I'm an airline pilot and I needed to recover quickly and completely from that, so with the motivation and physio, four days after the accident, my shoulder was taped and I began a little motion exercise. It's important because the more time you wait, the more the shoulder will be stiff afterward.

They gave me a lot of drugs and pain relievers. Finally, I did not take any of their drugs except the anti-inflammatory and a couple of Tylenol the first days. The first two or three days, I was unable to move the arm even an inch. After a week, I was able (slowly with the help of a wall) to move my arm straight above my head. Pain equaled ice for 10 to 15 minutes. I do exercises four times a day every day. After a month, it's not normal, and will probably look like that the rest of my life, but I have almost full range of motion, and strength has begun to come back a little bit, but the arm is rapidly tired.

After a month, I saw a doctor (Orthopedist). He say in the past, surgery was often the solution, but nothing proves that it's better than the physio (conventional rehab), plus the risks of surgery and longer recovery time. If in one year I still have pain, they will re-consider doing surgery

Now five weeks have passed since the accident. I'm not able to sleep on my shoulder and the arm still tires quickly and the bump of my collarbone is there, I wouldn't like to receive a hit on the shoulder, but I have a good 90 percent range of motion without too much pain. I am to be able to do faster movements with the arm (not playing tennis, but the reflexes of my arm are not painful compared to two weeks ago). I'm able to do 20 push-ups now (two weeks ago, 1/4 of one was so painful and I felt on the ground unable to go down). I always have a little pain or discomfort. I can feel it in the neck and the back. But sometime I forget the pain (so it's not too bad).

I continue to work on it, doing rehab with the pysio, motivation and I stay confident about to be able to go back to my job in about a month. I did start riding a bicycle after 10 days (watch the bumps), drove my manual transmission car after 15 days (still a little bit discomfort to reach fifth gear), and after four weeks I flew a little plane again and was back on a motorcycle for a smooth ride in the neighborhood. I went camping last weekend!

So, stay motivated, do not listen everything on the forums. A good doctor saw a lot of cases and knows more than one person who has a separated shoulder. Many hockey players have this kind of injury and continue to play! By the way, I'm 26, so it helped a little bit with my recovery, and before the accident I was in good shape but far from being an athlete! Good luck!

anon344188
Post 18

Get surgery ASAP after a grade three or higher separation. Do not listen to medical staff saying, "it will be normal again". It will never be normal again.

After my injury, I feel it is also most grossly negligent to tell people who have lost three major ligaments, the only ones that hold up your shoulder, that the shoulder "will be fine without them". We all need to push for far better treatment than "benign neglect".

Separating your shoulder is a far bigger deal than the medical professionals say. Of course since they can't, or won't do much about it, that is what they would say, but they all still want to be paid of course. I wish I had an incredibly high paying job that I get credit for, for doing absolutely nothing.

What a joke. Doctors that take credit for a shoulder not in the acute phase of pain. Excuse me, but that would stop anyway. Why is that a reason to "leave it"? If someone breaks their arm, it would eventually stop hurting and eventually you could kind of, sort of use it. Just like with a separated shoulder. So what is the difference? Basically, if you separate your shoulder past a grade 1, you are screwed. That's it. Also, I have read many an experience where some person is so proud that they "rehabbed the shoulder without surgery". No you didn't. If you did nothing for rehab, your shoulder would end up exactly the same.

If you want the best chance for real recovery, you need to get surgery in the first two weeks after the injury, preferably in the first four days. Personally. I would get the hook plate and the AC tightrope done at the same time. Yes, there will be a second surgery and more recovery time, but what is your goal? to be better? Or to just "do want I want for fun"?

Unless you are a pro athlete with a young gun in the background ready to take your place if you are out too long, get surgery and get over the fact you might miss a season of mountain biking, or whatever. It is an incredibly immature person who wants to get back to their regular physical activities after such a major injury.

anon337718
Post 17

I was wondering what type of shoulder brace you guys used for your shoulder pain? I come here all the time and read the articles you guys post and respect your opinion and I was hoping if you could point me in the right direction. I was looking at the selection at BraceAbility to see if I could find one that will work. What do you think?

anon334933
Post 16

I separated my shoulder in December 2011. It was a grade 3. After nine months, my ortho surgeon did a tendon graft with a titanium button/clasp tie-down. I am so happy I went for surgery. My arm had an almost 2" drop, plus my clavicle was sticking up badly. My back was so sore every day. It was like my muscles were sliding off my body. I lost almost all my muscle strength, and could not work out. I am a weightlifter so this was disturbing.

It took a lot to get surgery. I had to push hard. But I say get the surgery. Skip the Weaver-Dunn technique. Ditto with the hook. Go with a tendon graft and sutures. My bump is still there but barely, I can't see it through clothes, and my arm is in back up to the proper position (almost, some PT to do yet).

I had surgery in September 2012. I am cleared to lift weights again. I have 100 percent range of movement, no pain and I am getting stronger every day. I will be trying HGH to repair my AC joint as completely as possible. I am happy with my decision for surgery. I feel it was the only decision. And to all who are asking: No, the bump will never leave. No, your arm will not "move up" (despite what a PT or doc says, they are telling you that believing that, like a child, one day you won't care).

If you get surgery, expect six weeks in a sling. Do not stress your arm on anything! Expect six months to get back to any real athletic activity. But after that, your shoulder will be back as close to 100 percent as possible. This has been my experience.

anon294456
Post 15

I sustained a grade 2 separation playing football. It's my throwing shoulder (I'm a QB) so it's quite a big deal. Seven months have passed, and I'd say I'm up to about 70 percent recovery.

I've in effect been told that I'll never be 100 percent ever again. I was initially told with complete certainty that I would definitely regain 100 percent of my strength and mobility, so all in all, it's pretty disappointing.

anon279227
Post 14

About eight months ago, I had a surgery that uses a donor tendon to tie down my clavicle. I had a type 3 separation and was looking to get back into lifting. I had never considered taking any kind of steroids or anything before, but I've been playing with the idea of take growth hormones to strengthen the tendon.

I've been trying to take it slow in the gym for a while and I can't lift over 30 pounds without pain. If I took some kind of HGH, would that strengthen my donor tendon or would that just be a waste?

anon153310
Post 13

I have at type 3 separation last month. I had the surgery. They started my physio after one month. But i still can't lift my hand at the front. The physiotherapist says it's because of the muscles, but I'm not sure. --pritesh

anon117202
Post 12

I have just sustained a grade three AC joint separation from falling off my bicycle five days ago. Thank you to everyone for their comments. They were very helpful.

I am really sorry for my friends in the USA who have had to go through this without medical insurance. I wish you could pop over to the UK or Canada and have it done for free. Anyway I have been offered a number of operations by the NHS consultant and I have elected (after reading these comments) to go for the surgery. This involve screws instead of the c-hook that anon15302 (comment 2) talks about. Anyway wish me luck and I'll keep you updated.

anon112618
Post 11

I suffered a Grade 3 total separation. I couldn't decide whether to have surgery either.I finally decided to after it just didn't seem to heal completely and always hurt. It was supposed to be laparoscopic surgery but my doctor was not able to repair or sew the tendons back together. There was more damage than thought. Maybe that explains the constant hurt.

I now have donor tendons grafted in and the bone is back in place. Since the surgery was more invasive, I did end up with a five inch scar down the front of my shoulder but it feels much better now. My surgery was about three weeks ago and I am glad at this point that I had it done.

I did not have surgery for cosmetic reasons, so the scar is no big deal to me. I just wanted to be as close back to full use as possible. I am still facing therapy which I understand is suppose to be painful but it was the other way too. I hope this helps someone in their decision.

anon91681
Post 10

I have sustained a separated shoulder, type 2, in 2008. MRI is showing marketed tenderness in joint. One ortho surgeon told me it was a separated shoulder that didn't heal right and another ortho surgeon told me that physically he sees nothing wrong and that I'm fearful to use it.

I have four young boys and work in long term care, and I have no choice but to use it. When I do, I am plagued with pain in my neck and shoulder. My arm continues to feel weakened and my fingers and hand has sharp shooting pains.

Orthopedist #1 wants to do surgery and #2 doc says that there is nothing he can offer. Quite a fine predicament! All I know is that I have pain! Maybe arthritis set in? Initially, when I had the first x-ray, one doctor read the film and diagnosed osteoarthritis.

I'm only 39 years old. I'm wondering if constant use is only degenerating it more. Very confused and frustrated! Can anyone shed some light on this?

anon86936
Post 9

I'm 17, i crashed my snowboard and have a grade five separation in my shoulder. I'm a big softball player so i decided not to have surgery or i would miss the season.

I started to move my arm as much as i could as soon as i could so i could get my strength back with three weeks till season. I put my heart into it and i made the varsity shortstop position.

i made all league at the end of the year and I was also voted the most valuable player on my team. To answer the last question, no your shoulder will not come back up and the bump will stay. if you have surgery it will help the appearance a little, but not much.

my shoulder hurts every once in a while but not most of the time and i am waiting to have surgery in 2011 when i graduate.

anon69575
Post 8

It will not rise. I was diagnosed with a type III, but I think it's probably worse. It's been about eight years since the wreck, and it's definitely degrading.

I'm now starting to have degradation of the cartilage in my sternum from added stresses on the entire joint. I only know that because thank god for my good friend who used to be a charge nurse.

I could never afford a doctor in this country! Nor could I afford insurance. It's very much affecting my life now. For instance alcohol consumption has gotten bad! I can numb myself to sleep, and I hate that. Point being, if the injury is significant the solidarity, and structure of the entire joint is compromised. This puts excess forces on the surrounding structure. Over time this joint will be stressed. Pain will ensue. In my case it is sternum inflammation. It's painful, and very difficult to do anything about.

Be careful and be choosy about who you have do work on you. I wish you luck, and please wish it on me. I can't find a solution to this that I can afford. It's sad that we can only insure and treat the people that are in perfect health, but that's profitable and good business.

anon61584
Post 7

The surgery will provide almost immediate relief. I waited three years -- dumb decision. Get it fixed or it will cause problems later.

anon52437
Post 6

after i week, you should begin light (below shoulder height) movement.

Also, gaffa tape your arm at night so that it does not move in order to aid healing.

jeremytk
Post 5

I separated my shoulder and broke my collar bone when I was 14 and had surgery the next day, not knowing really what was wrong, but knowing it hurt like mad. I just went along with it. Now at 31, my shoulder hurts like mad again, right on top of my collar bone I assume arthritis.

anon27308
Post 4

i separated my shoulder about 5 years ago. seemed to heal up ok. no problems for about 4 years. dr said at time surgery was only cosmetic. over the past year its starting to bother me. may be arthritis. also loosing feeling in arm and hand, clicking sound when i move it. been to a few cheap drs paying cash. they seem to think i'm after drugs. i'm 39 with no insurance. i can't imagine another 10 years from now.

by the way, i went to the er at that time with no insurance. i would recommend anyone to go to a bone and joint dr. if i had the money i would gladly have surgery. hope this helps someone.

jwater2
Post 3

Maybe someone who has had the operation for type III shoulder separation can respond. I was rear ended while driving my motorcycle on the way to school one day. The x-ray shows that I have both ligaments torn. It is quite obvious by the size of the bump that I am considering the operation to lower the bump. Those people who have had the operation I hope can respond and tell me what should I expect if I go ahead with the operation.

anon15302
Post 2

I am having the same problems as well as a poking sensation when I lay down on my back near my shoulder blade and poor circulation in the arm. I've been to one doctor who said basically the same thing, but I've heard of a device that can be attached to the collarbone. It hooks under the acromion and holds the collarbone down, keeping tension off the ligaments while they heal. Anyone ever heard of this?

cliftonjh
Post 1

I separated my shoulder about a week ago, a supposed type 2, the swelling has now gone down significantly and my humerus is hanging almost an inch lower than where it is supposed to be, is that normal and will it come back up? should I still keep it in a sling or start moving it by now? my understanding was that after the first few days I was supposed to take it out of the sling and start moving it so it doesn't freeze. but I guess my main question is will it rise, how long will that take and what do I need to do to ensure the best healing results?

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