Introduction

This is an injury to the ligaments between the top of the shoulder blade (acromion) and the collarbone (clavicle).

Ligaments are tissues that connect bones to each other. In this injury, the ligaments may be stretched, partially torn, or completely torn.

A stretched ligament may not cause much pain, and it does not move the collarbone out of place. 

A stretched ligament looks normal on an X-ray.

A partial tear causes an injury that is a bit worse, and it may move the collarbone slightly out of place.

A complete tear causes serious injury. 

The surrounding shoulder ligaments are completely torn. 

This moves the collarbone out of position and creates a bad shape (deformity)of the shoulder.

What are the causes?

Common causes of this condition include:

Falling on the shoulder.

Receiving a hard, direct hit to the top of the shoulder.

Falling on an outstretched arm.

What increases the risk? 

You may be at greater risk of a shoulder separation if you:

Are male

Younger than 35 years of age.

Play a contact sport, such as football or hockey.

What are the signs or symptoms?

The most common symptom of this condition is pain on the top of the shoulder after falling on it or receiving a hard, direct hit to it. 

Other symptoms include:

·A change in the shape of the shoulder(deformity).

·Swelling of the shoulder.

·Decreased ability to move the shoulder.

·Bruising on top of the shoulder.

How is this diagnosed?

Your doctor may suspect a shoulder separation based on your symptoms and the details of a recent injury you experienced. 

The condition will be diagnosed based on:

·A physical exam. Your provider may:

o Press on your shoulder.

o Test the movement of your shoulder.

o   Ask you to hold a weight in your hand to see if the separation increases.

· Imaging tests, such as:

o X-rays.

o MRI.

How is this treated?

Treatment for this condition depends on the cause and severity of the injury.

·A shoulder separation caused by a stretched ligament may require 2–12 weeks of the following:

o Wearing a sling.

o Taking medicines to help relieve pain.

o  Applying cold packs to your shoulder.

o  Physical therapy. If needed, a physical therapist will teach you to do daily exercises to improve strength and prevent stiffness in your shoulder.

Surgery may be needed for severe injuries that include breaks (fractures) in a bone, or injuries that do not get better with nonsurgical treatments. To help with healing, you will need to keep your joint in place for a period of time (immobilization) and do physical therapy.

Follow these instructions at home:

-Medicines: Analgesics for pain management.

If you have a sling:

-Wear the sling as told by your healthcare provider. Remove it only as told by your doctor.

-Check the skin around the sling everyday. Tell your health care provider about any concerns.

-Loosen the sling if your fingers tingle, become numb, or turn cold and blue.

- Keep the sling clean.

- If the sling is not water proof:

o Do not let it get wet.

o  Cover it with a watertight covering when you take a bath or shower. 

General instructions

 -Do not use any products that contain nicotine or tobacco. These products include cigarettes, chewing tobacco, and vaping devices, such as E-cigarettes. These can delay healing. If you need help quitting, ask your doctor.

- Keep all follow-up visits. Your doctor will monitor how your injury is healing and adjust your activities. These may include visits for physical therapy. 

- Contact your doctor if:

o Pain medicine is not relieving your pain.

o Your pain and stiffness are not improving after 2 weeks.

o You are not able to do your physical therapy exercises because of pain or stiffness. 

Summary

A shoulder separation (acromioclavicular separation) is an injury to the ligaments between the top of the shoulder blade (acromion) and the collarbone (clavicle).The ligaments may be stretched, partially torn, or completely torn. Common causes of a shoulder separation include falling on or receiving a hard, direct hit to the top of the shoulder. Falling with an outstretched arm may also cause this injury. Rest your shoulder. Avoid activities that take a lot of effort for as long as told by your doctor.