No Need for Shoulder Separation Anxiety

Injuries referred to as “shoulder separations” are a common injury in athletics.1 These injuries are not of the ball and cup itself (glenohumeral joint), but rather the small joint just above where the collarbone meets the shoulder. This injury occurs typically when an athlete falls directly onto his or her shoulder or is hit directly on the outside of the shoulder. Shoulder separations are frequently seen in contact sports like hockey, football, and soccer, but can occur in any sport or activity.1,2

Shoulder separations represent almost half of all injuries to the shoulder region.1,2 There are several ligaments that stabilize the shoulder, and injury severity is based upon to what extent damage to these ligaments has occurred. Patients will describe pain in their shoulder, especially with movement, and may notice a “bump” on top, that represents the end of the collarbone. Most shoulder separations can be treated without surgery, but often do require a period of rest, icing, antiinflammatory medication, and physical therapy.2 Evaluation of these injuries will typically include X-rays to evaluate for fracture and sometimes an MRI if there is suspicion of injury to the joint. With more severe injuries, surgery may be recommended to improve longterm function and relieve pain.2 There are several different surgical procedures that are described for severe shoulder separation injuries depending upon the specifics and which ligaments are injured.

All surgical procedures for shoulder injuries will require a period of rest, recovery, and rehabilitation after surgery that can last up to 6–9 months depending on the type of surgery. Return to sports and activities with non-operative or operative treatment is based on a number of factors to include sport, position, and hand dominance. A throwing athlete like a baseball player or football quarterback who injures their throwing shoulder may require longer periods of time away, as compared to a soccer player for the same severity of injury. For athletes that wear shoulder pads, or even ones that do not, a hardshell or soft pad can be applied over the shoulder for a period of time during initial return to prevent symptoms and re-injury from repeat contact. With proper treatment, shoulder separations can be managed effectively and symptom-free return to activities and sport is the goal.

References 1. Kaplan LD, Flanigan DC, Norwig J, Jost P, Bradley J. Prevalence and variance of shoulder injuries in elite collegiate football players. Am J Sports Med. 2005. 33(8):1142-6. 2. Simovitch R, Sanders B, Ozbaydar M, Lavery K, Warner JJ. Acromioclavicular joint injuries: diagnosis and management. J Am Acad Orthop Surg. 2009. 17(4):207-19. 3. Williams GR, Nguyen VD, Rockwood CA. Classification and radiographic analysis of acromioclavicular dislocations. Appl Radiol. 1989. 18(2):29-34.