Separated shoulder | |
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Other names | Acromioclavicular joint injury, acromioclavicular separation, AC joint separation, AC separation |
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An Xray showing a separated shoulder. Notice the separation between the end of the collarbone and the scapula. | |
Specialty | Orthopedics, emergency medicine |
Symptoms | Pain, deformity, decreased range of motion[1][2] |
Types | Type I, II, III, IV, V, VI[2] |
Causes | Trauma such as a fall[2] |
Risk factors | Contact sports[3] |
Diagnostic method | Examination, X-rays[2] |
Differential diagnosis | Dislocated shoulder, clavicle fracture[4] |
Treatment | Type I and II: Sling and pain medication[2] Type III: Conservative management and surgery if still symptoms[2] Type IV, V, VI: Surgery[2] |
Frequency | Relatively common[3] |
A separated shoulder, also known as acromioclavicular joint injury, is a common injury to the acromioclavicular joint.[2] The AC joint is located at the outer end of the clavicle where it attaches to the acromion of the scapula.[2] Symptoms include non-radiating pain which may make it difficult to move the shoulder. The presence of swelling or bruising and a deformity in the shoulder is also common depending on how severe the dislocation is.[2][1]
It is most commonly due to a fall onto the front and upper part of the shoulder when the arm is by the side.[2] They are classified as type I, II, III, IV, V, or VI with the higher the number the more severe the injury.[2] Diagnosis is typically based on physical examination and X-rays.[2] In type I and II injuries there is minimal deformity while in a type III injury the deformity resolves upon lifting the arm upwards.[2] In type IV, V, and VI the deformity does not resolve with lifting the arm.[2]
Generally types I and II are treated without surgery, while type III may be treated with or without surgery, and types IV, V, and VI are treated with surgery.[3] For type I and II treatment is usually with a sling and pain medications for a week or two.[2] In type III injuries surgery is generally only done if symptoms remain following treatment without surgery.[2]
A separated shoulder is a common injury among those involved in sports, especially contact sports.[3] It makes up about half of shoulder injuries among those who play hockey, football, and rugby.[1] Those affected are typically 20 to 30 years old.[3] Males are more often affected than females.[3] The injury was initially classified in 1967 with the current classification from 1984.[1]