Shoulder Separation Infographic
A shoulder separation, an acromioclavicular joint injury, occurs when one or more of the ligaments that hold the clavicle to the scapula that forms the AC joint become strained or torn. The AC joint is located at the top of the shoulder where the front of the shoulder blade (the acromion) attaches to the collarbone (the clavicle). The joint is held together by ligaments, particularly the acromioclavicular and coracoclavicular ligaments that provide stability and maintain movement in the shoulder joint.
Common symptoms of a shoulder separation include immediate pain at the shoulder when the injury occurs, impaired movement of the shoulder, especially overhead movements, swelling or bruising at the shoulder, point tenderness at the top of the shoulder over the AC joint, a visible bump at the end of the collarbone, or a popping sound or feeling that the shoulder catches with movement.
There are several classifications of shoulder separation injuries. Grade 1 injuries are the most common type of injury and involve a sprain or slight tear in the AC ligament. A grade 2 injury involves a complete tear of the AC ligament, whereas a Grade 3 injury is a more severe injury in which the acromioclavicular and coracoclavicular ligaments are both torn and there is a visible bump on the shoulder. Grade 4-6 injuries are the most severe and require surgery to repair torn ligaments.
A shoulder separation can result from a traumatic impact on the shoulder such as a direct blow to or fall on the shoulder that causes the ligaments of the AC joint to stretch too far and strain or tear. This type of injury is common among young athletes who participate in contact sports such as football, rugby, and hockey. In fact, shoulder separations are one of the most common shoulder injuries in football, most often occurring due to a direct hit to the shoulder through a tackle. Most football-related AC joint separations occur during a game when a player is hit and tackled to the ground.
An American Sports Medicine Journal study found that over the course of 12 NFL season studied, there was a total of 2,485 shoulder injuries, 727 of which (29.2%) involved the AC joint. Researchers found that quarterbacks deal with AC injuries most frequently followed by special teams players, wide receivers, and defensive backs. The study also found that most shoulder separations were grades 1-3 and could be treated with physical therapy for a safe return to sport. In fact, only 1.7% of AC joint injuries required surgery over the 12-year period.
Physical therapy can effectively treat shoulder separations, helping athletes manage pain, restore shoulder mobility and strength, and return to sport safely. The physical therapist progresses the athlete through a four-phase rehabilitative program:
A brief period of immobilization with a sling to support the arm and shoulder and decrease stress on the AC joint. The physical therapist helps to manage pain and swelling.
The therapist then introduces gentle range of motion exercises and begins strengthening the scapular muscles. The therapist may also use manual therapy soft tissue mobilizations to increase mobility in the shoulder.
During this stage, the therapist will progress the athlete to advanced dynamic strengthening of the shoulder girdle and periscapular muscles to improve AC joint stability.
At this stage, the athlete can begin sport-specific functional training and continue with advanced shoulder strengthening, plyometric training, and kinetic chain exercises.
Have you experienced a shoulder separation? Work with a physical therapist today to manage pain and restore function in your shoulder!
