Separated shoulder; Acromioclavicular joint separation; A/C separation

Shoulder separation is not an injury to the main shoulder joint itself. It is an injury to the top of the shoulder where the collarbone (clavicle) meets the top of the shoulder blade (acromion of the scapula).

It is not the same as a shoulder dislocation.

Most shoulder separation injuries are caused by fall onto the shoulder. This causes a tear in the tissue that connects the collarbone and top of the shoulder blade. These tears can come froma:

• Fall
• Car accident
• Sports injury

The injury can make your shoulder look abnormal. This can be from the end of a bone sticking up or your shoulder hanging lower than normal.

Pain is usually at the very top of your shoulder.

Your health care provider may have you hold onto a weight while he or she examines you to see if your collarbone sticks out. An x-ray of your shoulder may help diagnose a shoulder separation.

Most people recover from this injury without surgery in 2 - 12 weeks. You will be treated with ice, medicines, a sling, and then exercises as you heal more.

Your recovery may be slower if you have:

• Arthritis in your shoulder joint
• Damaged cartilage (cushioning tissue) between your collarbone and top of your shoulder blade
• A severe shoulder separation

Your may need surgery right away if you have the following symptoms:

• Numbness in your fingers
• Cold fingers
• Muscle weakness in your arm
• Severe deformity of the joint

Make an ice pack by putting ice in a zip lock plastic bag and wrapping a cloth around it. Do no put the bag of ice directly on your skin. It could damage your skin.

On the first day of your injury, apply the ice every 10 - 15 minutes, for 20 minutes each time. After the first day, ice the area every 3 - 4 hours for 20 minutes each time. Do this for 2 days or longer.

For pain, you can take a type of medicine called NSAIDs. You do not need a prescription for these.

• Some examples of NSAIDs are ibuprofen (such as Advil or Motrin), naproxen (such as Aleve or Naprosyn), and acetaminophen (such as Tylenol).
• Do NOT give aspirin to children.
• If you have heart disease, high blood pressure, kidney disease, or have had stomach ulcers or bleeding, talk with your health care provider before usingthese medicines.
• Do not take more than the amount recommended on the bottle.

You may be given a shoulder sling to use for a few weeks.

• Once you have less pain, begin range of motion exercises so that your shoulder does not get stuck in position. This is called contracture. Make sure you check with your physician before doing any of these motions.
• After your injury has healed, do not lift heavier objects for 8 - 12 weeks.

If you continue to have pain, your health care provider will probably ask you to come back in about 1 week to decide if you need to:

• See an orthopedist (bone doctor)
• Begin physical therapy or range of motion exercises

Call your health care provider or go to the emergency room right away if you have:

• Severe pain
• Weakness in your arm or fingers
• Numb or cold fingers
• A sharp decrease in how well you can move your arm
• A lump on top of your shoulder that makes your shoulder look abnormal

Acromioclavicular (shoulder) separation. In: Buttaravoli P, ed. Minor Emergencies. 2nd ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 96.