Anatomy & Background
The shoulder blade and collarbone are joined together at the tip of the shoulder forming the acromioclavicular joint. The superior and inferior acromioclavicular ligaments and coracoclavicular ligament hold together the two ends of the shoulder blade and collar bone. In a shoulder separation, these ligaments are partially or completely torn. There are six levels of shoulder separation that vary based on the severity of the trauma:
- Type 1: the acromioclavicular ligament is partially torn, but the coracoclavicular ligament is intact.
- Type 2: the acromioclavicular ligament is completely torn, and the coracoclavicular ligament is intact or partially torn. The collarbone is partially separated from the acromion.
- Type 3: the acromioclavicular ligament and coracoclavicular ligament are completely torn. The collarbone and acromion are completely separated.
Types 4 through 6: are more severe and involve the tearing of muscle in addition to the joint separation.
A shoulder separation typically occurs due to a direct blow to the top of the shoulder,(for example, football, hockey or other high contact sports) or a fall onto an outstretched arm (FOOSH injury).
- Immediate and acute pain at the time of injury.
- Tenderness of the acromioclavicular joint.
- Swelling, tingling, aching and bruising may begin after the trauma.
- Pain that limits range of mobility.
- Possible bump or deformity where the acromion is separated from the clavicle.
Treating Shoulder Separation
The first task of managing a shoulder separation is to reduce the inflammation, temper acute pain and the immobilize the joint to prevent further injury. The treatment regiment for a shoulder separation is based upon the diagnosis of the type of separation and the severity:
- Type 1-2: separations are customarily placed in a sling to reduce pain and support the injury site. Physical therapy is started early to prevent frozen shoulder, increase your range of motion and strengthen the muscle.
- Type 3: separations are occasionally treated with surgery, but most respond to treatment with use of a sling combined with physical therapy. There is evidence to support that this nonsurgical approach is just as effective as surgery. Patients participating in overhead sporting activities or otherwise performing heavy lifting may benefit from surgery.
- Type 4-6: a trained health care professional should evaluate separations for surgery.
Physical Therapy Intervenes
If surgery is unnecessary, treatment will focus on the restoration of shoulder motion after the shoulder has been immobilized for a period of time to recover from the trauma. It is crucial to get the shoulder moving again while protecting the acromioclavicular joint to prevent frozen shoulder.
As the pain dissipates, strengthening exercises should be initiated to prevent muscle weakness and atrophy. Physical therapy following surgery for a shoulder separation will be delayed, but the program will have the same goals and purpose. Common treatment methods of a shoulder separation includes:
- Manual Therapeutic Technique (MTT) including mobilization, soft tissue massage and manual stretching to regain motion range and flexibility of the shoulder while protecting the acromioclavicular joint.
- Therapeutic Exercises (TE) to regain range of motion and strengthen the shoulder and surrounding joints by depressing and stabilizing the humeral head. This prevents it from irritating the acromioclavicular joint. Strengthening of the trapezius and deltoid muscles that help support the acromioclavicular joint should also be initiated.
- Neuro-muscular re-education to begin retraining the upper extremities for use in daily activities.
- Scapular and shoulder stabilization exercises to improve stability of shoulder and support the acromioclavicular joint may also be initiated.
- Modalities including the use of ultrasound, electrical stimulation, icing the area and cold laser to decrease pain at the shoulder.
- Home exercise program that includes stretching and strengthening exercises.
Patients suffering from simple separations usually recover full function of the area, especially when the ligaments sustain minimal damage. Severe cases requiring surgery have a longer recovery period, but many recover full function in a relatively short time frame.
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