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AC Joint (Shoulder) Separation

What is an AC joint separation?

An AC joint separation, also referred to as Shoulder Separation, occurs when there is an injury to the AC and CC ligaments. Depending on the severity and extent of the ligament damage, the clavicle may separate from the acromion. Moreover, we classify AC joint separations from type I to type VI based on the severity and extent of the ligament damage.

What is the AC joint?

The acromioclavicular (AC) joint in the shoulder provides stability and motion to the complex shoulder joint and is a common site of injury.  The AC joint is comprised of the clavicle (collarbone) and the acromion (one part of the shoulder blade). The clavicle, which allows for optimal shoulder function and range of motion, is one of the most commonly fractured bones in the human body. The AC joint is held together by the coracoclavicular ligaments (CC), the coracoacromial ligament (CA) and the AC ligament.  The clavicle is also the site of multiple muscle attachments, including the deltoid muscles, the pectoralis major, and the trapezius.

How does an AC joint separation occur?

These injuries are caused by a direct impact to the lateral aspect of the shoulder, typically from a fall directly on the shoulder. The AC joint is a common site of injury caused by auto accidents, falls from a bicycle and skiing.  AC joint injuries account for more than 40% of all shoulder injuries and nearly 10% of injuries from collision sports like football and ice hockey.

What are the symptoms of an AC joint separation?

Acromioclavicular joint pain ranges from mild tenderness to sharp, intense pain following injury. The pain is commonly felt at the top of the shoulder. The more severe the grade of the injury, the more severe the symptoms typically present. In addition to pain, common symptoms include tenderness at the joint, bruising, swelling, limited range of motion, pain with movement, instability, shoulder deformity and a bump on the top of the shoulder when the ligaments were disrupted.

Dr. Jonathan Godin is a world-class orthopaedic surgeon at the famous Steadman Clinic in Vail Colorado, with sterling credentials. His specialty is sports medicine and treatment of the shoulder, knee, and hip.  Dr. Godin’s focus is on his patients first and helping them to get well so they can return to the life they love whether they are pro athletes or weekend warriors. He takes cutting edge procedures and treatments from the lab and puts them into practice for his patients. 

How is an AC joint injury diagnosed?

Dr. Godin will conduct a comprehensive physical examination of the shoulder along with a detailed history and a series of x-rays to confirm a suspected AC joint injury.  An x-ray can also help rule out any additional injuries to the bone, such as a fracture of the end of the collarbone. In addition to x-rays, a diagnostic injection of local anesthetic may be performed.

What are AC Injury treatment options?

Treatments for AC injuries are determined by the severity of the injury and whether the ligaments are intact, sprained or torn. Most AC separations can be managed with non-surgical measures, depending on the level pain and function. Non-operative measures include wearing a sling, icing, anti-inflammatory medication and physical therapy.

An AC joint separation that involves tears of both the AC and CC ligaments can be managed non-operatively; however, if there is significant displacement of the joint and the patient relies on the joint for labor, or is an elite athlete, and conservative measures do not improve the condition, surgery will be considered.

Surgery may involve the trimming of the collarbone to eliminate rubbing against the shoulder blade.  When there is a significant deformity, ligament reconstruction surgery may be recommended to restore stability, and this can be performed arthroscopically or open. Moreover, this surgery is successful even when performed long after the injury or separation. Ultimately, the choice of treatment is made on a case-by-case basis. 

Regardless of the treatment, rehabilitation with physical therapy is essential to the restoration of range of motion, strength and flexibility.

When you or a loved one suffers a shoulder injury, contact Dr. Jonathan Godin, at the world-class Steadman Clinic in Vail, Colorado, will provide compassionate, personalized, state-of-the-art care. He welcomes national and international patients.

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