Shoulder Separation
Ashley Bowe, Karina Chornenka, Andrea Stojanovski
Shoulder separation:
Refers to the stretching or tearing of ligaments involving the
acromioclavicular joint (also called the AC joint). The AC joint is
where the collarbone (clavicle) meets the highest point of the shoulder
blade (acromion).
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Severity of injury: which ligaments are affected?
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Type I Involves trauma to the ligaments that form the
joint, but no severe tearing or fracture. It is commonly
referred to as a sprain and has mild swelling.
Treatment: anti-inflammatory drugs, sling, ice
Type II Involves complete tearing of the acromioclavicular ligament, and a sprain or
partial tear of the coracoclavicular ligaments. This often causes a noticeable,
permanent bump on the shoulder. Treatment: ice, bed rest, anti-inflammatory drugs,
physical therapy. Recovery 8-12 weeks.
Type III Both acromioclavicular and coracoclavicular ligaments are completely torn.
Once again, a significant bump is formed by the lateral end of the clavicle. The
clavicle can be moved in and out of place on the shoulder. Treatment: May take 12
weeks to heal with physical therapy. May require
surgery depending on the surgeon.
Type IV is a type III injury with avulsion of the
coracoclavicular ligament from the clavicle, with the
distal clavicle displaced posteriorly into or through
the trapezius. Treatment: requires surgery.
Type V is type III with exaggeration of the vertical
displacement of the clavicle from the scapula.
Treatment: This injury generally requires surgery.
Type VI is type III with inferior dislocation of the lateral end of the clavicle below the
coracoid. Treatment: It is extremely rare and requires surgery.
Caused by: A shoulder separation is usually caused by an impact to the front of the shoulder or by
falling on an outstretched hand. Often occur in people who participate in sports such as football, hockey,
rugby, snowboarding and wrestling.
Pain: Often it is easy to see the separation, with the distal end of the clavicle being noticeably
higher than the acromion (tip of the shoulder blade). The patient will usually have tenderness where
the acromion and the distal clavicle meet.
 CROSS-ARM TEST
The cross-arm test isolates the acromioclavicular joint. The patient
raises the affected arm to 90 degrees. Active adduction of the arm forces
the acromion into the distal end of the clavicle. Pain in the area of the
acromioclavicular joint suggests a disorder in this region