AC Separation

An AC joint separation typically results from a fall directly onto the shoulder with the arm at the side, or from a direct blow received in contact sports. This injury is common in athletes, particularly those involved in sports like football and hockey.

AC joint separations are classified into six types (Type I to Type VI) based on the severity of ligament damage, displacement of the clavicle, and involvement of nearby structures:

• Type I: The acromioclavicular ligament is partially torn but the coracoclavicular ligaments remain intact.
• Type II: The acromioclavicular ligament is completely torn and the coracoclavicular ligaments are either intact or slightly damaged.
• Type III to VI injuries are more severe, involving complete tears of both the acromioclavicular and coracoclavicular ligaments, with varying degrees of clavicle displacement.

The symptoms of an AC joint separation often include:

• Shoulder pain immediately following injury, especially at the top of the shoulder
• Swelling and bruising
• Limited shoulder movement due to pain
• A bump or bulge above the shoulder (for higher grade injuries)
• Arm weakness

Mild AC joint separations (Type I and II) often heal well with conservative treatment, including rest, ice, pain relievers, and a sling to immobilize the shoulder. However, more severe injuries may require surgical intervention to restore function.

The diagnosis is typically made based on a physical examination and the patient’s symptoms. Your shoulder surgeon Dr. Mayo will assess where on your shoulder you are most painful, as well as which motions cause you pain. X-rays are usually taken to confirm the diagnosis and classify the severity of the separation.

The treatment depends on the severity of the injury. Mild injuries can often be managed with rest, ice, pain medication, and physical therapy. More severe injuries, especially those that cause significant deformity or affect shoulder function, may require surgical intervention.

Surgery is usually considered for higher grade injuries (Type III and above) and for patients whose profession or athletic activities demand high levels of shoulder function. The timing of the surgery depends on the extent of the injury, the patient’s symptoms, and their overall health.

Surgery for an AC joint separation aims to repair or reconstruct the damaged ligaments and restore the normal alignment of the joint. Techniques may include using sutures, screws, or grafts to stabilize the joint. If surgery is decided upon within a few weeks from injury, the ligaments can be repaired arthroscopically using sutures. However, if surgery is delayed, the best option is a reconstruction of the ligaments which is a larger procedure.

After surgery, the shoulder is usually immobilized for a few weeks, followed by physical therapy to regain motion and strength. Most people can return to their normal activities within 3-6 months.