AC Joint Injuries

An acromioclavicular joint dislocation, often referred to as a shoulder separation, is a common injury among physically active individuals, particularly those involved in contact sports. This condition involves the displacement of the collarbone (clavicle) relative to the acromion, which is a part of the shoulder blade.

A dislocated/ separated shoulder is an injury to the ligaments that surround and stabilize the joint and hold the collarbone in place. Stretched or torn ligaments cause the collarbone to separate from the shoulder blade. It is not the same as a shoulder dislocation where the arm bone comes out of the shoulder socket.

A shoulder dislocation/separation is typically caused by a fall on an outstretched hand or a blow to the shoulder during sports or accidents.  These injuries are particularly common after biking injuries.  Less commonly, repetitive strain from overhead activities can gradually weaken the joint, leading to dislocation.

• Immediate and severe pain at the top of the shoulder following an injury.
• Swelling and bruising in the shoulder area.
• A visible bump or deformity on the shoulder, which is the displaced collarbone.
• Pain when lifting the arm or when trying to carry heavy objects.
• numbness or tingling near the injury that may go down the arm or up the neck.
• Reduced range of motion in the shoulder.

Dr. Kaplan will examine your shoulder and compare range of motion in the damaged shoulder with the uninjured shoulder. He will assess the shoulder for pain and swelling, and deformity. The injury is easily identifiable when there is a deformity. If the deformity is slight, the doctor will order x-rays to confirm the diagnosis and rule out a fracture. He will order x-rays to determine the extent of the dislocation and to assess for any associated fractures.

The severity of the dislocation is categorized into different grades, ranging from mild (where the ligaments are slightly stretched) to severe (where the ligaments are completely torn, and the collarbone is noticeably displaced). The severity of damage determines the treatment approach.

• A mild to moderate dislocation (Grads 1 and 2) sprain of the AC joint ligaments will look normal on an x-ray. It involves a sprain of the AC ligaments. Conservative nonsurgical treatment includes rest, icing, a sling, anti-inflammatory medications, pain medications, and physical therapy to restore function and strength. Recovery can take up to six weeks, but the deformity may persist.
• Severe dislocations (Grades 3 and above) are more serious injuries that tear the AC ligament and sprain or tear the Coracoclavicular ligament (CC ligament) and pull the collarbone out of alignment (the deformity). Surgical intervention may be recommended when the dislocation is severe, or the patient is highly active and requires full use of the affected shoulder.
• The aim of surgery is to reconstruct or repair the damaged ligaments to stabilize the joint. Reconstruction involves the removal and replacement of the torn ligaments with tissue grafts. Post-surgery, a period of immobilization followed by rehabilitation is necessary to restore strength and flexibility.

Rehabilitation exercises are crucial for both non-surgical and surgical treatments to help maintain shoulder strength, flexibility, and to prevent stiffness or chronic pain. The specific approach to treatment will be guided by factors such as the patient’s age, activity level, and the specific demands of their sports or activities.