What is shoulder separation?

A shoulder separation injury happens when trauma damages the ligaments around the acromioclavicular (AC) joint. It’s where the collarbone (clavicle) meets the shoulder blade (scapula). If the injury is severe, part of the shoulder blade may separate from the collarbone. A shoulder separation is not the same as a dislocation. In a dislocation, your upper arm bone (the humerus) pulls out of the shoulder joint. Shoulder separations are common, especially in active young adults.

Your shoulder blade connects to your upper arm bone and to your collarbone with ligaments. The highest point of your shoulder blade is called the acromion.

Injury may damage these ligaments around your joint. If the damage is severe, the collarbone and shoulder blade pull apart causing a shoulder separation. Your shoulder blade may move downward from the weight of your arm.

Healthcare providers rate injuries to the AC joint based on how severe they are. A type I injury is the most mild. A type VI injury is the most severe. In a type I injury, the AC ligaments are only partially torn, but the bones stay in place. In a type III injury, both the ligaments completely tear. Your collarbone and shoulder blade are slightly out of line. With more severe injuries, the bones pull out of position even more. There may also be damage to other tissues around the area.

What causes shoulder separation?

Different types of shoulder injuries can lead to shoulder separation. The most common cause is when you fall directly on the top of your shoulder, when your arm is close to your body. A direct blow to your shoulder, or falling onto an outstretched hand, can also cause the injury. Car accidents and sports injuries are possible causes.

What are the symptoms of shoulder separation?

Possible symptoms of shoulder separation include:

• Pain at the top of your shoulder

• Tenderness when touching your AC joint

• Swelling

• Deformity of your shoulder

• Limited range of motion in your shoulder. For example, when you try to lift your arm.

These symptoms vary depending on how bad the injury is. A type I injury may cause only slight pain, mild swelling, and a normal-appearing shoulder and arm. A slightly worse injury might cause greater pain and swelling, though the arm and shoulder may still appear mostly normal.

With a more severe injury, the top part of the shoulder may look deformed, and the pain and swelling may be more intense. The shoulder blade’s downward movement can cause a bulge above the shoulder, which also appears to droop. The collarbone may go far above the acromion of your shoulder blade. There may also be bruising of the area. In some cases, the collarbone may even poke out through the skin.

How is shoulder separation diagnosed?

Your healthcare provider will ask about your health history and give you a physical exam. They will look at your shoulder and arm and press on your AC joint, which may hurt.

More severe shoulder separation injuries are easy to diagnose with just a physical exam. This is because the shoulder will clearly look deformed. In any case, you will likely need an X-ray of your joint. This can help give more information about how severe your injury is. During the exam or X-ray, your healthcare provider might have you hold a weight on the injured side. This can make a deformity more obvious.

How is shoulder separation treated?

Your treatment will depend on the severity of your injury, and may include:

• Resting the joint with a sling or other support

• Use of cold packs

• Taking pain medicines

Your healthcare provider may show you special exercises to help rebuild your strength, flexibility, and range of motion as you heal. You’ll likely need to start these as soon as your pain starts to go away.

You may not need any other treatments if you have a type I, type II, or type III injury. If your injury is more severe, you may need surgery. Some type III injuries may also need surgery as well, especially for athletes. Your healthcare provider may first want to see if your AC joint heals on its own before trying surgery.

Surgeons have a number of ways to bring your collarbone back into alignment with the scapula. They might fix the bones together using screws. Or the ligaments that support your AC joint may be repaired. A ligament from another part of your body may be used to repair it.

Your end result may also depend on the severity of your injury. Most people will get back all or almost all normal arm and shoulder function, but a slight deformity may remain. If you have a mild shoulder separation, you may totally recover within a few weeks. More severe injuries may need greater recovery time.

What are possible complications of shoulder separation?

A small number of people continue to have pain in their AC joint for weeks or months after their injury. This might be due to abnormal contact between the bones. Arthritis can also develop in the joint because of your injury. You might eventually need surgery to treat these symptoms.

What can I do to prevent shoulder separation?

Most cases of shoulder separation are not preventable. You may be able to reduce your risk of shoulder separation by taking basic safety precautions. Make sure to always wear a seatbelt while driving or riding in a car. Use the proper protective gear for your sport.

How should I manage shoulder separation?

Your healthcare provider will give you instructions about when you can go back to your normal activities. Depending on the extent of your injury, this may take a few weeks, or it may be longer. Even after that, you may need to protect your joint from injury for a while, so that your ligaments can fully heal. Athletes may need longer recovery times.

Follow all your healthcare provider’s instructions. Make sure to do exercises as advised. This will help increase your chances for a full recovery.

When should I call my healthcare provider?

See your healthcare provider right away if you have injured your shoulder and think you might have a shoulder separation. Call your provider if your symptoms don't get better after your injury. Get emergency care if:

• You can’t move your arm at all

• You have numbness in your arm or hand

• The skin over the shoulder is deformed or punctured

• You have signs of poor circulation, such as a cool, pale hand

Key points about shoulder separation

In a shoulder separation, trauma damages the ligaments around your AC joint. This joint is where your collarbone and shoulder blade meet. If the injury is severe, the acromion of your shoulder blade separates from your collarbone.

• Symptoms of shoulder separation include pain at the top of the shoulder and a deformed look to the shoulder.

• Your healthcare provider may treat you with ice, movement restriction, pain medicines, and exercises. If you have a more severe injury, you may need surgery as well.

• Most people fully recover from a shoulder separation injury.

• A small number of people will have symptoms months after their injury. Surgery may help.

• Follow your healthcare provider’s orders about returning to your normal activities after your injury. This is especially true if you are an athlete.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions.