Shoulder Separations by Paul D. Reynen, MD, Sanford Clinic Orthopedics & Sports Medicine
Shoulder separations are a common athletic injury. They usually occur from a fall or a blow to the point of the shoulder. Common examples would be a hockey player hitting the boards or being tackled in football. This may result in an injury to the acromioclavicular joint (AC joint). This is the connection between the end of the collar bone and the acromion (which is the bone you feel right under the skin on the top of your shoulder). This is not a "shoulder dislocation”. These two terms are commonly confused and the treatment is much different.
AC joint injuries range in severity from mild sprains (Grade 1) to complete disruption of the joint and may demonstrate the common “bump” on the top of the shoulder (Grade 3). While these injuries can be quite painful at the time, they can usually be treated without surgery and many athletes can return to play within a few weeks.
While the diagnosis can typically be made on the field, it is important to be evaluated in the clinic as well to make sure there are no associated injuries or fractures. Initial symptoms are treated with rest, ice, anti-inflammatory medications and usually some type of immobilization, such as a sling. In the majority of athletes, the treatment and rehab will be based on their comfort and function. Gentle range of motion exercises are started when they are able and then gradual strengthening. Athletes are allowed to return to play when they have normal range of motion and strength. Athletic trainers and therapists will often make a pad for the shoulder to help protect the shoulder from contact. It is common to still have some discomfort as they play but the shoulder should function adequately. Re-injury is always a concern when returning to a contact sport.
As is true with any joint injury, this can produce some future issues such as arthritis in some people. There are also more severe forms of this injury that would be better treated with surgery and some athletes may be advised not to play. There are many things to consider in determining the best way to handle each particular situation and should be discussed with the Sports Medicine professional who is providing your care.
Dr. Paul Reynen is an orthopedic surgeon for Sanford Clinic Orthopedics & Sports Medicine specializing in arthroscopic surgery of the knee and shoulder. Dr. Reynen serves as the team orthopedic surgeon for the University of South Dakota, Augustana College, Sioux Falls Pheasants and the Sioux Falls Skyforce.
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