Separated shoulder

Separated shoulder / shoulder separation / AC separation / AC joint separation

A separated shoulder is also called shoulder separation, AC joint separation or AC separation. In this case, the AC joint (acromioclavicular joint) and the collarbone are not in their normal position anymore. The shoulder becomes unstable and different symptoms may occur.

Symptoms separated shoulder / shoulder separation / AC separation / AC joint separation

Subject to the severity of the separated shoulder, different symptoms of various extents can emerge. Afflicted persons often feel pain in or around the shoulder and the collarbone. The collarbone may also rise significantly and form a bump. There can be also hematomas or swellings of the shoulder and the collarbone. The affected arm may also be twisted inwards to avoid pain and movements. Range of motion and the movability of the shoulder and the corresponding arm are often restricted. Shoulder instability may also occur. Severe shoulder dislocations may result in the piano key sign. The piano key sign is present if the collar bone raises causing a bump you can push down like a piano key. Even lying on the shoulder can be very painful.

The symptoms of the separated shoulder in short:

  • pain in and around shoulder and collarbone
  • pain while moving arm and shoulder
  • pain while lying at the shoulder
  • restricted range of motion of arm and shoulder
  • shoulder instability
  • protruding of collarbone (bump)
  • hematoma / swelling
  • relieve posture of the arm

Causes separated shoulder / shoulder separation / AC separation / AC joint separation

The separated shoulder is generally caused by an external force like falling at the shoulder or a hit at the shoulder. Almost everybody who has ever watched the Tour de France or bicycle races in their life, have also been confronted with bicyclist falling down on their shoulders. Such a traumatic event may cause the shoulder to separate.

Subject to severity, a shoulder separation may also entail strains, partial or complete rupture of capsules, ligaments, muscles and joints, raised collarbones and a partial or complete instability of the shoulder.

Diagnostics separated shoulder / shoulder separation / AC separation / AC joint separation

The diagnosis separated shoulder necessitates a comprehensive orthopedic examination. Often imaging procedures like MRI or X-raying are used to differentiate different diseases that may cause similar or the same symptoms like the impingement syndrome. The best method to differentiate between different injuries is MRIMRI enables us to visualize very different structures during one examination like muscles, ligaments, tendons, cartilage and bones. If it is necessary, we do also apply a well-tolerated contrast agent to improve the visibility of certain structures.

In some cases, it may be necessary to perform a shoulder arthroscopy, during which an endoscope is inserted through small incisions to visualize the different structures of the shoulder enlarged. If indicated, a subsequent arthroscopic surgery is possible directly after the arthroscopic examination.

Crucial for the treatment is to evaluate the extent of the shoulder separation, if something is strained, torn, partially or completely unstable, etc. Helpful are the corresponding categorizations according to Tossy and Rockwood in 4 to 6 grades.

Therapy separated shoulder / shoulder separation / AC separation / AC joint separation

There are different treatment options subject to extent and severity of the shoulder separation. If it is a moderate shoulder separation with minor damage of the capsule and ligament structures, patients have to wear a bandage/sling and are treated with painkilling as well as anti-inflammatory drugs. In combination with physiotherapy and rehabilitation measures, this kind of treatment has good results.

If capsule and ligament structures are severely damaged and further structures of the shoulder are not in their normal position anymore, arthroscopic surgery is indicated.

During minimally invasive shoulder arthroscopy, an endoscope is inserted through small skin incisions. With the help of the endoscope, the surgeon is able to see the damaged shoulder structures enlarged at a monitor. In addition to that, surgeons are also able to operate through the endoscope and repair or stabilize the AC joint (acromioclavicular joint), the collarbone and other affected structures of the shoulder. The separated shoulder and the accompanying pain and restricted range of motion can be treated this way.

After arthroscopic surgery, physiotherapy and rehabilitation should follow in order to improve strength and range of motion.

Read more about minimally invasive shoulder arthroscopy